NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL
ELIGIBILITY INFORMATION SYSTEM EIS 2200
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EIS 2200 - WITHDRAWING AN APPLICATION
I. GENERAL INSTRUCTIONS
II. WITHDRAWING ONE-PART APPLICATIONS (Application Types 1, 2, and 6)
III. WITHDRAWING TWO-PART APPLICATIONS (Application Types 4 and 5)
IV. NOTICE OVERRIDE
V. SIGNATURES AND DATE
VI. SUBMIT THE DSS-8124 TO DATA ENTRY FOR KEYING.
VII. OUPUTS
VIII.GENERAL INFORMATION FOR AUTOMATED WITHDRAWAL NOTICES
IX. THE SYSTEM GENERATED DSS-8109A
EIS 2200 - WITHDRAWING AN APPLICATION
REVISED 10/01/96 - CHANGE NO. 2-96
I. GENERAL INSTRUCTIONS
REVISED 10/01/96 - CHANGE NO. 2-96
II. WITHDRAWING ONE-PART APPLICATIONS (Application Types 1, 2, and 6)
Use the following instructions to withdraw a one-part application.
A. For one-part ongoing applications, complete entries in the PROSPECTIVE DISPOSITION fields.
B. For one-part retroactive Medicaid applications, complete entries in the RETROACTIVE DISPOSITION fields; and/or
C. Check the withdrawal block in the TYPE field.
D. Enter the DISPOSITION DATE. This is the date the applicant requests withdrawal of the application. This cannot be a future date.
E. Enter a withdrawal code in the REASON field. See the Codes Appendix for the appropriate withdrawal code.
PLEASE TURN TO PAGE 4 TO CONTINUE.
REISSUED 10/01/02 - CHANGE NO. 02-03
III. WITHDRAWING TWO-PART APPLICATIONS (Application Types 4 and 5)
A. Each piece of a two-part Medicaid application (Application Types 4 and 5) may be dispositioned (approved/denied/withdrawn) at any time for any reason, regardless of whether the other part is being dispositioned.
B. Complete entries in the PROSPECTIVE DISPOSITION fields if you are withdrawing the prospective part of an application; and/or
Complete entries in the RETROACTIVE DISPOSITION fields if you are withdrawing the retroactive part of an application.
C. Check the withdrawal block in the TYPE field.
D. Enter the DISPOSITION DATE. This is the date the applicant requests withdrawal of the application. This cannot be a future date.
E. Enter a withdrawal code in the REASON field. See the Codes Appendix for the appropriate withdrawal code.
PLEASE TURN TO PAGE 4 TO CONTINUE.
REVISED 10/01/02 - CHANGE NO. 02-03
IV. NOTICE OVERRIDE
Enter "Y" in NOTICE OVERRIDE if you wish to send a manual notice when you withdraw an application. Otherwise an automated notice will be sent based on the withdrawal code used.
V. SIGNATURES AND DATE
A. Enter Caseworker Signature.
B. The county director or his designee must sign and date the form in the DIRECTOR'S SIGNATURE and DATE field.
VI. SUBMIT THE DSS-8124 TO DATA ENTRY FOR KEYING.
VII. OUPUTS
VIII.GENERAL INFORMATION FOR AUTOMATED WITHDRAWAL NOTICES
A. The DSS-8109A, Notice of Denial or Withdrawal of Public Assistance, is applicable for all aid programs/categories.
B. An automated notice (DSS-8109A) is produced for each withdrawal the night the DSS-8124 processes in the system unless "Y" is entered for "NOTICE OVERRIDE." A sample of the DSS-8109A is located at the end of this section.
C. The WITHDRAWAL REASON CODE entered on the DSS-8124 determines the text of the notice.
D. The system calculates the 60th calendar day for the notice.
E. The date of the automated notice is the next state workday after the DSS-8124 processes. This is the date the notice is mailed to the recipient. A copy of the notice is not mailed to the county.
REISSUED 3/01/98 - CHANGE NO. 8-98
VIII. (CONT’D)
F. A Notice Register Report is produced each night and is mailed to the county the following workday. This report lists vital information related to all automated notices produced for that day. See EIS 2304 for more information regarding the Notice Register Report.
IX. THE SYSTEM GENERATED DSS-8109A
A. The format is designed for a two-window envelope. The applicant's address is printed on the right with the county DSS's address printed in the upper left corner of the notice.
B. The system prints the information for the DSS-8109 based on the data entered on the DSS-8124 and keyed in EIS. The information entered includes:
1. Date Mailed
2. Worker Number
3. County DSS Phone Number
4. County Case Number
5. Case ID
6. Date of Application
7. Aid Program/Category
8. Applicant Name and Address
The system indicates the application is withdrawn and prints the reason for withdrawal. The reason text printed on the notice is the same as the text in the withdrawal codes table. Refer to the Codes Appendix for the withdrawal codes. The appropriate manual reference number is also indicated, as well as the 60th day.
C. For two part Medicaid applications, the system issues notices based on the disposition action.
1. If both parts are dispositioned on the same day with the same reason code, one notice is produced.
2. If both parts are dispositioned on the same day with different reason codes, two notices are produced.
3. If one part is dispositioned and the other pended, the notice produced refers to the part being dispositioned. For example: "Your application for retroactive Medicaid is being withdrawn." In the space following this sentence, the system prints a message confirming that the remaining part of the application is still in pending status.
ISSUED 3/01/98 - CHANGE NO. 8-98
IX. (CONT’D)
D. To ensure the applicant is notified in a timely manner, it is imperative that the DSS-8124's be keyed promptly. If not, the notice issuance is delayed.
