Customer Contact Center Food Stamp/Family Medicaid Phase II ...

Call Center FS & FM Phase II PG February 29, 2008
Initial Application
STAT-FS for Margaret Simmons
• Margaret’s statement is accepted as verification of her relationship to the
children.
INTERVIEW ASSISTANCE STATUS - STAT STAT A
Month 11 06 0071 10 0506 01
AU ID 674173806 Prog FS Prog Type S Prev ABD Type Med COA Claim N
CO 049 LO 049 Load ID 1700 Conversion Date
AU AU Status AU Stat Appl Begin Pd Thru ---Penalty---- Appeal
Stat Reasons Date Date Date Date Type End Date Ind
P 100506 100506
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
First Last Rel V Mand Finl --Stat-- Rsn Appl Begin Pd Thru Penalty
Name Name Incl Resp Date Date Date Date T Date
MARGAR SIM SE OT Y PN P 100506 100506
SUSAN SIM CH OT Y PN P 100506 100506
TINA SIM CH OT Y PN P 100506 100596
Message 0013 01
0013 REQUIRED FIELDS ARE IDENTIFIED BY "?"
20-rmen 22-alau(arch) 23-alau(curr)
STAT Documentation Requirements:
• Verification of I.D.
• Whether there are any other HH members
• Explanation of denials /closures entered by the worker
• Name, age, relationship of non-AU members and an explanation of why
they are not included in the AU.
• If non-AU members purchase and prepare separately and meet the
criterion for separation, document the policy that allows them to be
separate.
PG-10