NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3104

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INSTRUCTIONS FOR MAKING CHANGES TO SPECIAL ASSISTANCE CASES

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EIS 3104 - DMA-5022 INSTRUCTIONS FOR MAKING CHANGES TO SPECIAL ASSISTANCE CASES


I. GENERAL INSTRUCTIONS

II. COMPLETE SECTION A OF THE DMA-5022 TO REQUEST EITHER PAYMENT LISTED IN I. ABOVE. FOLLOW THE INSTRUCTIONS BELOW. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

III. COMPLETE SECTION C OF THE DMA-5022 TO REQUEST A STATE ISSUED ADJUSTED PAYMENT OR PRIOR MONTH PAYMENT. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

IV. COMPLETE THE SIGNATURES AND DATES SECTION.

V. SUBMIT THE DMA-5022 TO DATA ENTRY FOR KEYING.

VI. OUTPUTS


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EIS 3104 - DMA-5022 INSTRUCTIONS FOR MAKING CHANGES TO SPECIAL ASSISTANCE CASES

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

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I. GENERAL INSTRUCTIONS

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II. COMPLETE SECTION A OF THE DMA-5022 TO REQUEST EITHER PAYMENT LISTED IN I. ABOVE. FOLLOW THE INSTRUCTIONS BELOW. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

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III. COMPLETE SECTION C OF THE DMA-5022 TO REQUEST A STATE ISSUED ADJUSTED PAYMENT OR PRIOR MONTH PAYMENT. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

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

III. Continued

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IV. COMPLETE THE SIGNATURES AND DATES SECTION.

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V. SUBMIT THE DMA-5022 TO DATA ENTRY FOR KEYING.

REVISED 11/01/01 - CHANGE NO. 06-02

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VI. OUTPUTS

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