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

Call Center FS & FM Phase II PG February 29, 2008
Initial Application
DEM2 for Margaret Simmons
Margaret:
• is a US Citizen; client provided birth certificate
• is a high school graduate
• Note: When a code is placed in this field, SUCCESS will pre-populate the
High School Grad/GED field on the WORK Screen
INTERVIEW CLIENT DEMOGRAPHIC 2 - DEM2 DEM2 01
Month 11 06 1001 10 05 06
Client Name MARGARET SIMMONS Client ID 771006042
Citiz V Student V High Grade V Striker ------Immunization ------ Law -Health Chk -
Stat Completed Stat Curr GCse Due Dt Brkr Ref Date
C BC 12 CS N
TPL TPL V --------- Medicare -------- --------------- Disability / Incapacity ---------------
Coop Entitlmnt Claim Num Disab Approval Begin Date End Date
Type Source (MM YYYY) (MM YYYY)
N
Joint Vet Military Death TANF Cap Parent ---------- TANF Cap Child ---------
SSI/FS Stat Serv Num Date Ctr End Date Parnt ID Rcv Mo Cncpt GCse
N
Non-Custodial Parent?
V
Message
15-lett
DEM2 Documentation Requirement:
22-tpl 23-alau
• Details of disability / incapacity
• Details, resolution of Death Match matches
• Date of conviction, if conviction meets the lawbreaker criteria and how it
was verified
• Circumstances resulting in penalty/disqualification for any fleeing felons or
probation/parole violators
There is no ADT to meet this documentation requirement. Press F9 to
document on REMA.
PG-13