NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2015

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COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS, REAPPLICATIONS AND
ADD-AN-INDIVIDUAL FOR S-AA, S-AD, AND S-CD

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EIS 2015 - COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS, REAPPLICATIONS, AND ADD-AN-INDIVIDUAL FOR S-AA, S-AD, AND S-CD


I. GENERAL INFORMATION

II. COMPLETING AN APPLICATION FORM

III. OUTPUTS


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EIS 2015 - COMPLETING AN APPLICATION FORM FOR NEW APPLICATIONS, REAPPLICATIONS, AND ADD-AN-INDIVIDUAL FOR S-AA, S-AD, AND S-CD

REVISED 08/01/04 - CHANGE NO. 01-05

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I. GENERAL INFORMATION

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II. COMPLETING AN APPLICATION FORM

REISSUED 08/01/04 - CHANGE NO. 01-05

II. A. (cont’d)

REISSUED 10/01/12 - CHANGE NO. 01-13

II. A. 11. (cont’d)

REVISED 10/01/12 - CHANGE NO. 01-13

II. A. (cont’d)

REVISED 10/01/12 - CHANGE NO. 01-13

        DISPOSITION FIELDS ARE NOT USED IN APPLICATION REGISTRATION. REFER TO THE DENIAL (EIS 2150) AND WITHDRAWAL (EIS 2200) SECTIONS FOR INSTRUCTIONS ON HOW TO DENY OR WITHDRAW THE APPLICATION AT REGISTRATION.

      21. When necessary, a WITNESS SIGNATURE may be entered.
      22. Sign the DSS-8124 in the CASEWORKER SIGNATURE field.
      23. The county director or his designee must sign and date the form in the DIRECTOR'S SIGNATURE and DATE field.

    B. Key the DSS-8124 or submit it to Data Entry for keying.

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III. OUTPUTS

    EIS produces a DSS-8124I Application Turnaround overnight when the application is entered and accepted into the system. State staff mail the DSS-8124I to the county the next workday.

    NOTE: The name on the DSS-8124I must match Social Security Records. Use the name on the SDX, BENDEX, SOLQ, TPQ, Social Security Card, or Medicare Card. If a discrepancy exists, use the name from the online verification.

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