NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 4900

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DATA ENTRY APPENDIX C CHILD SUPPORT – REFERRAL SCREENS

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EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORTEIS/ACTS INTERFACE, PART TWO


I. REFERRALS AND UPDATES TO IV-D

II. GENERAL INSTRUCTIONS

III. REFERRAL QUESTION SCREENS

IV. REFERRAL SCREENS

V. ADD-ON APPLICATIONS

VI. REAPPLICATIONS, INCLUDING ADMINISTRATIVE ACTIONS

VII. SPIN-OFF APPLICATIONS

VIII. GOOD CAUSE CLAIM AT APPLICATION


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EIS 4900 – DATA ENTRY APPENDIX C - CHILD SUPPORT
EIS/ACTS INTERFACE, PART TWO

REFERRAL SCREENS
REVISED 09/01/97 - CHANGE NO. 03-98

Top Of Page

I. REFERRALS AND UPDATES TO IV-D

REISSUED 09/01/97 - BY CHANGE NO. 03-98

I.A. (CONT'D)

Top Of Page

II. GENERAL INSTRUCTIONS

REISSUED 09/01/97 - CHANGE NO. 03-98

II. (CONT'D)

REVISED 09/01/97 - CHANGE NO. 03-98

II. (CONT’D)

REISSUED 08/01/01 - CHANGE NO. 02-02

II.N. (CONT’D)

REVISED 08/01/01 - CHANGE NO. 02-02

Top Of Page

III. REFERRAL QUESTION SCREENS

MEDICAID REFERRAL QUESTIONS FOR APPLICATIONS:

MEDICAID REFERRAL QUESTIONS FOR CASES:

REVISED 08/01/01 - CHANGE NO. 02-02

III. (CONT'D)

REVISED 08/01/01 - CHANGE NO. 02-02

III.B. (CONT'D)

REVISED 08/01/01 - CHANGE NO. 02-02

REVISED 08/01/01 - CHANGE NO. 02-02

III.B. (CONT'D)

Top Of Page

IV. REFERRAL SCREENS

REVISED 08/01/01 - CHANGE NO. 02-02

IV. A.

982S3-DEPRIVED CHILDREN

This screen displays in the referral process when the MEDICAID REFERRAL question about both parents living in the home is answered Y.

Enter "S" beside any children that have both parents living in the home. The selected children will not be included in the referral to IV-D.

REISSUED 08/01/01 - CHANGE NO. 02-02

IV. B.

983S1-REQUIRED CLIENT DATA

Use this screen to enter additional data that is not in EIS related to the casehead/payee. Data may be entered for a casehead included in the application/case as a recipient or a payee only.

If this is an application/case with only one individual on it, and you have answered Y to IS THE EIS CASEHEAD A CHILD RECIPIENT UNDER AGE 21, WHO LIVES WITH A CARETAKER? on the MEDICAID REFERRAL QUESTIONS screen , the CASEHEAD PAYEE NAME, CASEHEAD ID and demographic data will not be brought forward to this screen. The caseworker must enter the name and demographic data of the child's caretaker on this screen. This individual becomes the ACTS client.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. B. (CONT'D)-REQUIRED CLIENT DATA

If this is a case where you are changing casehead/payees, and you have answered Y to IS THIS AN ACTION FOR A NEW CASEHEAD/PAYEE AND THE OLD CASEHEAD/PAYEE IS BEING REFERRED AS AN ABSENT PARENT?, on the MEDICAID REFERRAL QUESTIONS screen, EIS displays the new casehead/payee’s individual data on this screen.

If this is a case where you are changing casehead/payees, and you entered the new casehead/payee’s EIS Individual ID on the IVD Menu under KEY A REFERRAL, EIS displays the new casehead/payee’s individual data on this screen.

REQUIRED CLIENT DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case.

CASEHEAD PAYEE NAME

This is the caretaker with whom the child lives, if any. This person becomes the ACTS client.

DATE OF BIRTH

The date of birth of the client

RACE

The race of the client

SEX

The gender of the client

SSN

The Social Security number of the client

AS OF

The date the client began living at this address

CASEHEAD/CLIENT WORK PHONE

The client's work phone number

REVISED 09/01/97 - CHANGE NO. 03-98

IV. C.

400S1-ADDITIONAL CLIENT DATA

This screen displays in the referral process if the OTHER INFORMATION question at the bottom of the REQUIRED CLIENT DATA screen is answered Y. Use this screen to enter additional data not contained in EIS about the client.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. C. (CONT'D)

ADDITIONAL CLIENT DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent for this case

MAIDEN NAME

Last name of client at birth

SECONDARY NAME

Another name other than a person's legal name, by which they are or have been known, such as another married name, for a woman, or any other name a person has used

FOOD STAMP CASE NUMBER

Case number of the Food Stamp case in which this family receives benefits

SSI?

Supplemental Security Income -Enter Y or N to indicate whether or not the client currently receives SSI benefits

SSA?

Social Security Administration-Enter Y or N to indicate whether or not the client currently receives Social Security benefits (RSDI)

ADDRESS1

Client's home address, if different from mailing address

CLIENT HOME PHONE

Telephone number at client's residence

ADDRESS2

Second line of client's home address

AS OF

The date when the individual began living at this address

CITY

Self-explanatory

EMPLOYER NAME

Name of business where client is employed

EMPLOYER PHONE

Telephone number of business where client is employed

EMPLOYER ADDR1

Address of business where client is employed

EMPLOYER ADDR2

Second line of client's employer's address, ie Building #, Suite #, etc.

EMPLOYER CITY

City in which client's employer is located

STATE

Self-explanatory

ZIP

Self-explanatory

WAGES

Monthly gross wages of client

REVISED 09/01/97 - CHANGE NO. 03-98

IV. D.

401S1-LIST OF ABSENT PARENTS

This screen displays in the referral process after the REQUIRED CLIENT DATA or ADDITIONAL CLIENT DATA screen. Use this screen to list the absent parent(s) of children on this application/case. Enter the EIS Individual ID for each absent parent. See EIS 1056, Common Name Database for instructions for identifying/assigning an EIS Individual ID. A maximum of 15 absent parents per application/case can be entered.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. D. (CONT'D)

EIS displays the individual data from the Common Name Database for the EIS Individual ID(s) entered. Review the individual information to ensure it is correct.

If data is correct, answer the question at the bottom, IS ALL DATA CORRECT? by entering a Y.

LIST OF ABSENT PARENTS SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

EIS IND ID

The EIS Individual ID for the absent parent

NAME, RACE, SEX, BIRTHDATE

Absent parent info-EIS displays from Common Name Database

AGE

The age of the absent parent. Enter this only if the date of birth is not known. (If data of birth is entered, EIS calculates AGE.)

REVISED 09/01/97 - CHANGE NO. 03-98

IV. E.

402S1-EIS AP/CHILD RELATIONSHIPS

This screen displays in the referral process after the LIST OF ABSENT PARENTS screen. Use this screen to indicate which children belong to an AP and the AP's relationship to them.

EIS displays the name and EIS Individual ID of the first AP listed on the LIST OF ABSENT PARENTS at the top of the screen. Once all information has been entered on the referral for the first AP, this screen displays for the second AP, if any, and the referral information for the second AP can be entered. This continues until all AP's listed on the LIST OF ABSENT PARENTS screen have been displayed and all information has been entered into the referral for each one.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. E. (CONT'D)

EIS AP/CHILD RELATIONSHIPS SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

MOTHER

The mother of the child

LEGAL FATH

The legal father of the child, as determined by marriage to the mother at the time of the child's birth or establishment of paternity

PUT FATH

The putative father of the child, to whom the mother is not married at the time of the child's birth or for whom paternity has not been established

REVISED 09/01/97 - CHANGE NO. 03-98

IV. F.

410S1-AP SUPPORT ORDER DATA

This screen displays in the referral process when the answer to the SUPPORT ORDER question on the EIS AP/CHILD RELATIONSHIPS screen is Y. Use this screen to enter support order data. There can be only one type of support per screen. There can be as many as three types of support per docket number. Enter an "S" to select appropriate data related to this court order.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. F. (CONT'D)

AP SUPPORT ORDER DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case.

COURT ORDER DOCKET NUMBER

The number used by the court system to identify individual actions

ORDER EFFECTIVE DATE

The date a support order is entered

COURT NAME

The name of the court where an action occurred

SUPPORT TYPE:

Section title only-Select one from the list below.

CHILD (SUPPORT)

Money paid by a parent for the support of a child

MONEY FOR MEDICAL

Money paid towards medical bills for a dependent

MEDICAL INSURANCE

Provision of health insurance for a dependent

SPOUSAL (SUPPORT)

Money paid by one spouse for the other spouse

PAYMENT FREQUENCY:

Section title only-Select one from the list below.

PAYMENTS MADE THROUGH:

Section title only-Select one from the list below.

COURT (PAYMENT MADE THROUGH)

Used to indicate support paid through court

DHR

The procedure for paying support payments directly to DHR, not to a court or individual

DIRECT TO RECIPIENT

Support paid by a parent directly to the client rather than through Clerk of Court or IV-D

CLIENT TURNS OVER TO DHR

Procedure for client to pay to DHR all child support received directly by her, not retaining it herself. Usually found on out of state orders.

RETAINED BY CLIENT

The support payments are paid directly to the client and kept by the client

AMT OF SUPPORT ORDERED/MODIFIED

Amount of support ordered to be paid per payment period on original order or modified order

AMT OF ARREARAGE

The client's statement of the amount of back child support owed

LAST PAYMENT AMT

Amount of last support payment

LAST PAYMENT DATE

Date last support payment received by client

REVISED 09/01/97 - CHANGE NO. 03-98

IV. G.

410S2-SUPPORT ORDER CHILDREN

This screen displays after the AP SUPPORT ORDER DATA screen displays. Use this screen to indicate which children are included in the support order entered on the previous screen. Enter an "S" to select appropriate children.

REVISED 09/01/97 - CHANGE NO. 03-98

REVISED 09/01/97 - CHANGE NO. 03-98

IV. H.

403S1-AP INDIVIDUAL DATA

This screen displays in the referral process after the EIS AP/CHILD RELATIONSHIPS screen if the answer to the SUPPORT question is N and the answer to the MORE INFORMATION question is Y.

This screen displays after the SUPPORT ORDER CHILDREN screen if the answer to both questions is Y. Use this screen to enter additional information about the absent parent.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. H. (CONT'D)

AP INDIVIDUAL DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

ALIAS

Another name, other than a person's legal name, by which they are or have been known , a nickname

MAIDEN NAME

The AP's last name at birth

SECONDARY NAME

Another name other than a person's legal name, by which they are or have been known, such as another married name, for a woman, or any other name a person has used

RELATIONSHIP OF AP TO CASEHEAD

Relationship of AP to the casehead/payee..such as child, husband, etc.

GOOD CAUSE CD

Enter S to the left of the appropriate Good Cause Code, pending, approved, denied.

MARRIAGE DATE

The date the AP and casehead/payee were married, if applicable

SEPARATION/DIVORCE DATE

The date the AP and casehead/payee were separated or divorced, if applicable

MAILING ADDRESS

The address at which the AP receives mail-This field is the title of the section only. Fields under MAILING ADDRESS are for mailing address to be entered.

HOME ADDRESS

The address at which the AP actually lives-This field is the title of the section only. Fields under HOME ADDRESS are for home address to be entered.

ADDR1

First line of address

ADDR2

Additional line of address

INTN"L COUNTRY

The country, other than the US, in which the individual resides

INTN"L ZIP

The zip code for the country, other than the US, in which the individual resides

MAILING ADDRESS AS OF DATE

The date when the AP began receiving mail at the address

WORK PHONE

AP's telephone number at work

HOME ADDRESS AS OF DATE

The date the AP began living at the stated address

HOME PHONE

The telephone number at the AP's residence

REVISED 09/01/97 - CHANGE NO. 03-98

IV. I.

404S1-MORE AP INDIVIDUAL DATA

This screen displays in the referral process after the AP INDIVIDUAL DATA screen if the MORE INFORMATION question at the bottom of that screen is answered Y. Use this screen to enter additional information about the AP.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. I. (CONT'D)

MORE AP INDIVIDUAL DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

BIRTH-CITY

The city in which this individual was born

COUNTY

The county in which this individual was born-enter county number, up to 3 digits. Lead zero allowed but not required.

STATE

Self explanatory

DRIVER LIC #

The AP's driver's license number

SSN

The AP's Social Security number

LICENSE PLATE #

The tag number on an AP's license plate

SSI?

Supplemental Security Income -Enter Y or N to indicate whether or not the AP currently receives SSI benefits

SSA?

Social Security Administration-Enter Y or N to indicate whether or not the AP currently receives Social Security benefits (RSDI)

HEIGHT

The physical height of this individual, 5 spaces. Can be 6' 3", 74", 6ft3, or any other combination of letters or numbers

WEIGHT

The weight of this individual-up to 3 numbers.

IDENTIFYING MARKS

Scars, tattoos, birthmarks, etc If more space is needed, enter SEE NOTES and enter data on the NOTEPAD.

HAIR COLOR

Color of AP's hair, if any

EYE COLOR

Color of AP's eyes

PROVIDES IN KIND SUPPORT?

Whether or not the AP pays support in goods, rather than money, such as milk and Pampers

PROVIDES DIRECT SUPPORT?

Whether or not the AP pays support directly to the client

ON AFDC?

Whether or not the AP is on AFDC

USUAL OCCUPATION

The AP's usual occupation, such as salesman, brick mason, etc.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. J.

405S1-AP EMPLOYMENT DATA

This screen displays in the referral process if the answer to the EMPLOYMENT question on the MORE AP INDIVIDUAL DATA screen is Y. Use this screen to enter information about the AP's current and/or previous employment. Enter most current employer first.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. J. (CONT'D)

AP EMPLOYMENT DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

EMPLOYERS

(Nothing can be entered here. This is just a title for the section.)

NAME

Name of the business where the AP is employed

PH

Employer's phone number

BEG DATE

The date the AP began working with this employer

ADDR1

The first line of the address of the AP's employer

ADDR2

The second line of the AP's employer's address, such as Building, Suite, etc

CITY

Self-explanatory

STATE

Self-explanatory

ZIP

Self-explanatory

WAGES

The AP's gross monthly wages

REVISED 09/01/97 - CHANGE NO. 03-98

IV. K.

406S1-AP MILITARY DATA

This screen displays in the referral process when the MILITARY SERVICE question on MORE AP INDIVIDUAL DATA screen is answered Y. Use this screen to enter data related to the AP's military service.

Enter an "S" to the left of the appropriate branch of the military in which AP is currently or was previously serving.

Enter an "S" to the left of the appropriate status.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. K. (CONT'D)

AP MILITARY DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

MILITARY BRANCH

Section title-nothing can be entered here. Select one of the options listed

STATUS

Section title-nothing can be entered here. Select one of the options listed

SERVICE END DATE

The date of discharge from military service

REVISED 09/01/97 - CHANGE NO. 03-98

IV. L.

407S1-AP CRIMINAL DATA

This screen displays in the referral process when the MORE INFORMATION question on the MORE AP INDIVIDUAL DATA screen is answered Y. Use this screen to enter data about the AP's bank accounts and criminal record data.

Enter an "S" to the left of the appropriate ACCOUNT TYPE to indicate the type of bank account AP owns, if any.

CONVICTED OF CRIME? and ON PROBATION? require only a "Y" or blank.

Enter an "S" to the left of FELONY or MISDEMEANOR to indicate the CONVICTION TYPE.

Other fields are self-explanatory and accept a text answer.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. L. (CONT'D)

AP CRIMINAL DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

NAME OF BANK

The name of the bank where AP's account is located.

CHECKING

A bank account on which checks can be drafted

SAVINGS

A bank account for the purpose of saving money

MONEY MARKET CHECKING

A draft account against a money market account

PLACE OF ARREST-CITY

The city where an AP was arrested

CONVICTED OF CRIME?

Whether or not an AP was convicted of a crime

CONVICTION TYPE

Select felony or misdemeanor

CONVICTION DATE

The date the AP was convicted of a crime

FELONY

Type of crime, more serious than misdemeanor

ON PROBATION?

Whether or not the AP is currently on probation

MISDEMEANOR

Type of crime, less serious than a felony

PRISON/JAIL ADDRESS

The address of the prison or jail in which the AP has been or is currently incarcerated

PRISON/JAIL CITY

The city in which the prison or jail is located in which the AP has been or is currently incarcerated

PRISON/JAIL NAME

The name of the prison or jail in which the AP has been or is currently incarcerated

STATE

Self-explanatory

ZIP

Self-explanatory

REVISED 09/01/97 - CHANGE NO. 03-98

IV. M.

408S1-AP SPOUSE/PARENT DATA

This screen displays in the referral process when the MORE INFORMATION question on the MORE AP INDIVIDUAL DATA screen is answered Y. Use this screen to enter data about the AP's parent(s) and most recent spouse other than the client.

NOTE: Only one space is provided for parent's address. If parents live at different addresses, enter one address on this screen and the other on the NOTEPAD.

REISSUED 09/01/97 - CHANGE NO. 03-98

IV. M. (CONT'D)

AP SPOUSE PARENT DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

FATHER"S NAME

The father of an absent parent

MOTHER"S NAME

The mother of an absent parent-Enter mother's maiden name as middle name.

PARENT"S ADDR1

The mailing address of either of the AP's parents

PARENT" ADDR2

The second line of the AP's parent's address

CITY

The city in which AP's parent lives

STATE

Self-explanatory

ZIP

Self-explanatory

INT"L COUNTRY

The country, other than the US, in which the AP's parents live

INT"L ZIP

The zip code of the country, other than the US, in which the AP's parents live

MOST RECENT SPOUSE NAME

The name of the person to whom the AP was most recently married, other than the client

MOST RECENT SPOUSE MARRIAGE DATE

The date of the AP's most recent marriage to someone other than the client

MOST RECENT SPOUSE SEPARATION/DIVORCE DATE

The date of separation or divorce of the AP from the most recent spouse other than the client

REVISED 09/01/97 - CHANGE NO. 03-98

IV. N.

409S1-CHILDREN BEING REFERRED

This screen displays in the referral process when all appropriate AP screens have displayed. Use this screen to enter additional data not contained in EIS for each child for whom a referral is being made.

• The following information is required on this screen:

REVISED 09/01/97 - CHANGE NO. 03-98

IV. N. (CONT'D)

CHILDREN BEING REFERRED SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

RELATIONSHIP OF CHILD TO CASEHEAD

The relationship of this child to the caretaker with whom it lives. Select one.

IS CHILD’S MINOR PARENT A PARTICIPANT ON THIS CASE?

Enter Y or N to indicate whether this child’s minor parent is a recipient or casehead/payee on this case.

MINOR PARENT’S ID NUMBER:

Enter the EIS Individual ID for the minor parent.

NAME:

EIS displays the name of the minor parent whose ID was entered when you press ENTER.

SSI?

Supplemental Security Income -Enter Y or N to indicate whether or not the child currently receives SSI benefits

SSA?

Social Security Administration-Enter Y or N to indicate whether or not the child currently receives Social Security benefits

FOOD STAMP CASE NUMBER

Case number of the Food Stamp case in which this family receives benefits

SIS #

The id number for this child in the SIS system, if any

BIRTH-CITY

The city where the child was born

COUNTY

The county where the child was born, up to 3 numbers. Lead zero allowed but not required.

STATE

The state where an individual was born, 2 letter code

STATE OF CONCEPTION

Geographic location where child was conceived, 2-letter code for state

CHILD BORN OUT OF WEDLOCK

Whether or not the child's mother was married at the time of its birth.

FATHER ON BIRTH CERTIFICATE

Name of father on child's birth certificate, if any

PATERNITY/GENETIC TEST PERFORMED

Whether or not the test to determine a child's natural father has been performed on this child

ON WHOM(MPI#)

The MPI number of the AP on whom paternity testing has been performed, either the actual or dummy MPI number

PATERNITY ESTABLISHED?

The court procedure for establishing a child's legal father or child born to a married mother

(PATERNITY) ACKNOWLEDGED?

Whether or not the child's father agrees he is the natural father

IN COURT?

Whether or not paternity has been established in court

IN WRITING?

Whether or not paternity has been established in writing

AFFIRMATION OF PATERNITY SIGNED?

Whether or not the Affirmation of Paternity is signed

EMPLOYMENT INFORMATION FOR CHILD?

Whether or not there is employment information for the child

REVISED 09/01/97 - CHANGE NO. 03-98

IV. O.

405S1-CHILD EMPLOYMENT DATA

This screen displays in the referral process if the EMPLOYMENT question at the bottom of the CHILDREN BEING REFERRED screen is answered Y. Use this screen to enter employment data for a child included in the EIS case.

• The following data is required on this screen:

REISSUED 09/01/97 - CHANGE NO. 03-98

IV. O. (CONT'D)

CHILD EMPLOYMENT DATA SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

EMPLOYERS

Section title only, nothing can be entered here.

NAME

Name of the business where the child is employed

PH

Employer's phone number

BEG DATE

The date the child began working with this employer

ADDR1

The first line of the address of the child's employer

ADDR2

The second line of the child's employer's address, such as Building, Suite, etc

CITY

Self-explanatory

STATE

Self-explanatory

ZIP

Self-explanatory

WAGES

The child's gross monthly wages

REVISED 09/01/97 - CHANGE NO. 03-98

IV. P.

411S1-EIS NOTEPAD TO ACTS

This screen displays in the referral process after all other screens have been displayed. Use this screen to enter certain information needed by IV-D and any other information the IMC wants the IV-D worker to have. Each screen can have 12 lines of text There can be as many as three NOTEPAD screens per application/case. Text must begin on first line under TEXT.

If data is being sent to IV-D about an individual, enter the individual's MPI # or EIS Individual ID and name.

If the worker needs to send data to IV-D that will not fit into the space allotted to it on the referral screens, enter SEE NOTES in the field and use the NOTEPAD to enter that data.

• The following information is required on this screen:

REVISED 09/01/97 - CHANGE NO. 03-98

IV. P. (CONT'D)

NOTEPAD SCREEN

 

FIELD NAME

DESCRIPTION OF DATA TO BE ENTERED

EIS ID #

The EIS individual id number of the individual to which this message refers

IV-D AGENT ID

The worker number of the IV-D agent assigned to this case

ACTS MPI #

The individual id number assigned to this individual by the ACTS system-Master Participant Index number

NAME

The name of the individual about whom this note is being written

TEXT

This is where you enter any other information you wish to send to the IV-D agent

The following information should ALWAYS be entered on the NOTEPAD, if applicable.

HEALTH INSURANCE-If your county does immediate referral, ensure IV-D knows about health insurance at referral time. When the DMA-2041 is entered, that data is automatically sent to IV-D for cases/individuals for which a referral has been done. If the application is denied, and you are an immediate referral county, ensure health insurance information is relayed to IV-D with the denial.

HIGH PRIORITY CASES-Indicate when the following situations exist:

Client knows a lot about AP or has frequent contact

High medical costs

High potential for medical support/insurance exists

Special needs.

Support order does not include medical insurance.

MULTIPLE AP'S-When multiple AP's exist for a child and little is known about them, explain situation here.

NON-COOPERATION-If IV-D notifies the county that the client has not cooperated, and the county determines there was a good reason for not cooperating, enter that information here. This is not a determination of GOOD CAUSE, but situations such as client did not go for IV-D interview because she was in the hospital and is still willing to cooperate.

PATERNITY ISSUES-Enter any other information relevant to paternity issues.

PREGNANT RECIPIENT-Indicate pregnant client or minor mother

REFUSAL TO COOPERATE-If the client refuses to name the absent parent, assign an EIS Individual ID with UNKNOWN UNKNOWN for the AP's name. Enter a note on the NOTEPAD that the client refuses to cooperate.

REVISED 09/01/97 - CHANGE NO. 03-98

IV. P. (CONT’D)

EJA421SI-SUMMARY OF IVA-IVD DATA

This screen displays the EIS case information as well as the name and individual id of the client, each child referred to IV-D and each absent parent. Print this screen for the case record to maintain a record of the absent parent’s individual id. If your county has immediate referral to IV-D, print a copy of this screen for IV-D or the client, depending on the procedure in your county.

Press ENTER. If this is a pending application, EIS holds the referral until the application is dispositioned. If this is an active case, EIS sends the referral to IVD immediately. Press PF2 to exit and delete the referral.

The EIS Inquiry Menu displays.

REVISED 09/01/97 - CHANGE NO. 03-98

Top Of Page

V. ADD-ON APPLICATIONS

Top Of Page

VI. REAPPLICATIONS, INCLUDING ADMINISTRATIVE ACTIONS

REVISED 09/01/97 - CHANGE NO. 03-98

Top Of Page

VII. SPIN-OFF APPLICATIONS

Top Of Page

VIII. GOOD CAUSE CLAIM AT APPLICATION

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