NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3102

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CHANGES TO RRF AND SA CASES

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EIS 3102 – CHANGES TO R-RF AND SA CASES


I. COMPLETING THE ADDRESS

II. SIGNATURES AND DATE

III. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

IV. OUTPUTS:

V. FOR ANY CHANGE NOT LISTED, SEE "OTHER CHANGED DATA."


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EIS 3102 – CHANGES TO R-RF AND SA CASES

CHANGE OF ADDRESS

REISSUED 10/01/09 – CHANGE NO. 01-10

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I. COMPLETING THE ADDRESS

REVISED 10/01/09 – CHANGE NO. 01-10

I. A. 9. (CONT'D)

        b. Enter the facility's unique identification code in the last three spaces of ADDRESS LINE 2. Refer to EIS 1063 to determine the appropriate 3 digit facility code.

          Example:

          Line 1 Gastonia Vlg

          Line 2 850 Majestic 934

      10. Enter the CITY, STATE, and ZIP CODE. See EIS 4050, the Address Appendix, for appropriate state abbreviations.

      11. INDIVIDUAL LEVEL - Enter the RELATIONSHIP TO PAYEE code. See Codes Appendix to determine the appropriate code.

    B. DO NOT ENTER the following fields on the DSS-8125:

      1. Verification Indicator
      2. Change Code
      3. Notice Override
      4. Application Data
      5. Case Termination Data
      6. County Issue and Prior Month Payment Data
      7. Medicaid Effective Date
      8. Retro MA 1 and 2
      9. Work Experience
      10. Educational Level
      11. Issue CRD (See EIS 3105 for how to request replacement cards.)

        NOTE: ALL OTHER FIELDS ARE OPTIONAL. A DETAILED EXPLANATION OF EACH FIELD IS INCLUDED IN "OTHER CHANGED DATA".

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II. SIGNATURES AND DATE

    A. Enter the DATE COMPLETED.

    B. Sign the DSS-8125 in the WORKER'S SIGNATURE field.

    C. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

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III. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

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IV. OUTPUTS:

    When the DSS-8125 processes successfully, the following are received:

    A. Case Profile

REISSUED 10/01/05 – CHANGE NO. 02-06

IV. A. (CONT'D)

      An updated Case Profile is produced the night the change processes and is mailed to the county on the following workday.

    B. Caseworker Supervisor Report

      All changes completed by an IMC are reported on the Caseworker Supervisor Report. The number of actions completed is determined from the WORKER NUMBER.

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V. FOR ANY CHANGE NOT LISTED, SEE "OTHER CHANGED DATA."

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