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NC DEPARTMENT OF HUMAN RESOURCES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM REISSUED 09/01/97

TRANSMITTED BY CHANGE NO. 3-98 EIS 4900

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DATA ENTRY APPENDIX CèCHILD SUPPORT

EIS/ACTS INTERFACE, PART FIVE

AP DATA FORM

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

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

AP DATA FORM
REISSUED 09/01/97 - CHANGE NO. 03-98

I. AP DATA FORM

Because of the requirement for outstationing and doing home visits, it is suggested that Medicaid workers have a paper form to use to collect information to complete a referral to IV-D. This form can also be used at times when EIS is down, as some counties have night and Saturday hours. The form follows the automated referral as closely as possible, so that the worker may easily key the automated referral from the information on the paper form.

The following form is a suggested format for collecting data needed for a referral. Print the three pages separately, so workers can use as many absent parent and child data sheets as needed for each case, without duplicating case level data. EIS casehead/payee name and date can be entered at the top of each page for identification purposes.

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