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. USE THE DSS-8125 TO COMPLETE ANY CHANGES TO REFUGEE OR SPECIAL ASSISTANCE CASES. THE FIELDS LISTED BELOW ARE REQUIRED ENTRIES FOR ANY CHANGE:

II. THE FOLLOWING FIELDS MAY BE CHANGED OR UPDATED AS NEEDED UNLESS OTHERWISE INDICATED. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

III. SIGNATURES AND DATE

IV. Key THE DSS-8125.

V. OUTPUTS

OTHER CHANGED DATA

REVISED 10/1/05 – CHANGE NO. 02-06

I. USE THE DSS-8125 TO COMPLETE ANY CHANGES TO REFUGEE OR SPECIAL ASSISTANCE CASES. THE FIELDS LISTED BELOW ARE REQUIRED ENTRIES FOR ANY CHANGE:

A. Case ID.

B. County Number.

C. Aid Program/Category.

NOTE: FOR KEYING INSTRUCTIONS SEE EIS 4900, Appendix E.

II. THE FOLLOWING FIELDS MAY BE CHANGED OR UPDATED AS NEEDED UNLESS OTHERWISE INDICATED. IF A NUMERIC FIELD REQUIRES LESS DIGITS THAN SPACES AVAILABLE, PRECEDE WITH ZEROES.

A. CASE LEVEL DATA

1. CASE ID: Enter the eight digit Case ID from the current Case Profile. This number does not change.

2. WORKER NUMBER: This is a three digit alpha/numeric field. Enter or correct your worker number.

3. COUNTY NUMBER: Enter your two digit county number from the Case Profile.

4. COUNTY CASE NUMBER: This is a six digit alpha/numeric field. Enter or correct the case number from the Case Profile.

5. DISTRICT NUMBER: This is a three digit alpha/numeric field. Enter or correct the district number from the Case Profile.

6. COUNTY REASSIGNMENT NEW COUNTY NUMBER AND DATE: See "County Transfers for Active Cases," EIS 3500.

7. AID PROGRAM/CATEGORY: The aid program/category must be the same as the current aid program/category. If you are changing the aid program/category see “Aid Program/Category Transfer”, EIS 3452.

8. CASEHEAD/PAYEE NAME: See “PAYEE NAME CHANGES AND CHANGES OF PAYEE”.

9. CASEHEAD PAYEE CHANGE: See "PAYEE NAME CHANGES AND CHANGES OF PAYEE".

10. ADDRESS: See “Change of Address”.

REVISED 10/1/05 – CHANGE NO. 02-06

II. A. CASE LEVEL DATA (CONT'D)

11. PHONE NUMBER: This is a numeric field. Enter the three-digit area code and seven-digit phone number of the casehead/payee initially or to correct the phone number on the Case Profile.

12. VERIFICATION INDICATOR: Do not enter for changes.

13. SUBSTITUTE PAYEE: See “"SUBSTITUTE PAYEE”.

NOTE: IF THERE IS A TWO PARENT CASE, ENTER A CODE 21 AND THE SECOND PARENT NAME.

14. CHANGE CODE: Enter for SA payment revisions. (Not applicable for R-RF.) The change code is not required for transfers to or from SA.

15. NOTICE OVERRIDE: Enter “Y” to override the S-AA,
S-AD, or S-CD automated adequate or timely notice. (Not applicable for R-RF.)

16. APPLICATION DATA fields: Do not enter. See the appropriate Approving An Application, Reapplication, or Add -An - Individual Section.

17. CASE TERMINATION DATA fields: Do not enter. See EIS 3200, "Terminating a Case."

B. PAYMENT DATA

1. PAYMENT REVIEW PERIOD: Do not enter. See “Approvals” or “Redeterminations”.

2. MONTHLY PAYMENT AMOUNT: This is a five digit, whole dollar field. If entered, you must enter PAYMENT EFFECTIVE DATE.

a. For Refugee cases, the amount must be the MAINTENANCE AMOUNT, minus the TOTAL COUNTABLE INCOME, divided by 2, minus any GRANT RECOUPMENT.

b. For Special Assistance cases, the amount must be the MAINTENANCE AMOUNT, minus the TOTAL COUNTABLE INCOME, minus any GRANT RECOUPMENT.

3. MONTHLY PAYMENT TYPE: Enter “4” or “5” for transitional cases. Enter “1” for R-RF or SA. If changing MONTHLY PAYMENT TYPE from “1” to “4”, “5” or “9”, you must enter MEDICAID EFFECTIVE DATE.

REVISED 10/1/05 – CHANGE NO. 02-06

II. B. 4. (CONT'D)

4. MONTHLY PAYMENT EFFECTIVE DATE: The date must be the current processing month. If entered, you must enter MONTHLY PAYMENT AMOUNT. Update payment effective date when:

a. Adding Or Including An Individual

b. Deleting An Individual

c. Grant Recoupment Data Changes

d. Maintenance Amount Changes

e. Monthly Payment Amount Changes

f. Total Countable Monthly Income Changes

C. MEDICAID DATA

1. MEDICAID STATUS: Do not enter.

2. MEDICAID EFFECTIVE DATE: If entered, this eight digit field must be the first day of the current processing month. Update Medicaid Effective Date when:

a. Adding An Individual.

b. Aid Program/Category Transfers.

c. Medicaid Classification Changes (SA cases only).

d. Redeterminations

e. Ambulation Capacity Changes

3. MEDICAID CERTIFICATION FROM AND THRU DATES: Do not enter.

4. MEDICAID CLASSIFICATION (SA cases Only): This is a one digit field. See the Codes Appendix to determine the appropriate Medicaid classification code. If the Medicaid classification changes, you must update the MEDICAID EFFECTIVE DATE.

If the CLASSIFICATION IS “Q”, mark “Y” for MEDICARE A at the individual level.

5. DB/PML AMOUNT: Do not enter.

6. RETRO MA 1 and 2: Do not enter.

REISSUED 07/1/10 – CHANGE NO. 01-11

II. B. 4. (CONT'D)

D. EARNED INCOME

NOTE: EARNINGS ARE ENTERED AT CASE LEVEL FOR SA CASES ONLY. DO NOT ENTER FOR R-RF CASES.

1. GROSS EARNED INCOME: This is a six digit, numeric, dollars and cents field.

2. DISREGARD: This is a six digit, numeric, dollars and cents field.

3. WORK EXPENSES: This is a six digit, numeric, dollars and cents field.

4. NET EARNED INCOME: This is a six digit, numeric, dollars and cents field.

5. CHILD/ADULT CARE: This is a six digit, numeric, dollars and cents field.

6. GRANT RECOUPMENT CODE: Enter this one digit field if a recipient is repaying an overpayment by reduction in the check. See the EIS 4000 Codes Appendix to determine the appropriate grant recoupment code. If entered, PAYMENT AMOUNT, PAYMENT EFFECTIVE DATE, RECOUPMENT AMOUNT, and END DATE are required.

7. GRANT RECOUPMENT AMOUNT: This is a four digit, numeric, whole dollar field. If entered, RECOUPMENT CODE and END DATE are required. For the Grant Recoupment amount is brought forward from the Automated Budget.

8. GRANT RECOUPMENT END DATE: This is a four digit, numeric code which must be MMYY. The date must not be before the current processing month. If entered, RECOUPMENT CODE and AMOUNT are required.

E. UNEARNED INCOME

1. SSI AMOUNT: DO NOT ENTER FOR R-RF CASES. This is a six digit, numeric, dollars and cents field. If entered, SSI STATUS must be “Y”. (Can only be entered for SA cases that have SSI status of “Y”.

2. RSDI AMOUNT: This is a six digit, numeric, whole dollar amount field. If entered, the amount must be equal to or less than the TOTAL NET UNEARNED INCOME and TOTAL COUNTABLE MONTHLY INCOME fields for RRF. For SA, the amount cannot be equal to TOTAL COUNTABLE MONTHLY INCOME. See TOTAL COUNTABLE MONTHLY INCOME field. The RSDI Claim Number must be entered.

REVISED 07/1/10 – CHANGE NO. 01-11

II. E. 3. (CONT'D)

3. Other Unearned Income Amount: This is a six digit, numeric, dollars and cents amount field. The amount of other unearned income in addition to RSDI and or SSI. (Example: VA Pensions, etc.)

4. TOTAL NET UNEARNED INCOME: This is a six digit, numeric, dollars and cents field. If entered, the amount must be greater than or equal to the RSDI Amount for RRF. For SA, the amount must be greater than or equal to the sum of SSI and RSDI amounts.

NOTE: WHEN BUDGETING EARNED INCOME FOR AN INDIVIDUAL WHO IS NOT A RECIPIENT, OR FOR AN INDIVIDUAL WHO IS BEING DELETED FROM THE CASE, INCLUDE THE NET INCOME IN THIS FIELD. DO NOT ENTER THIS INDIVIDUAL'S INCOME IN THE INDIVIDUAL INCOME FIELDS.

F. NEEDS DATA

1. MAINTENANCE AMOUNT: This is a six digit, numeric, whole dollar field. Enter zeroes for cents. If entered, the PAYMENT AMOUNT and PAYMENT EFFECTIVE DATE are required.

2. AMBULATION CAPACITY: DO NOT ENTER FOR R-RF CASES. This is a one digit alpha code. See the Codes Appendix to determine the appropriate ambulation capacity code.

3. DOMICILIARY RATE: DO NOT ENTER FOR R-RF CASES. This is a six digit, numeric, dollars and cents field. If entered, the amount must be less than the MAINTENANCE AMOUNT.

4. TOTAL COUNTABLE MONTHLY INCOME: This is a six digit, numeric, dollars and cents field. This field is required if TOTAL NET UNEARNED INCOME is entered. If entered, the following is required:

a. PAYMENT AMOUNT and PAYMENT EFFECTIVE DATE. When changing TOTAL COUNTABLE MONTHLY INCOME and not the PAYMENT AMOUNT, enter the PAYMENT AMOUNT and the PAYMENT EFFECTIVE DATE indicated on the current case profile.

b. The amount must be the TOTAL NET UNEARNED INCOME plus NET EARNED INCOME of all individuals on the case for RRF. For SA, the amount must be TOTAL NET UNEARNED INCOME plus NET EARNED INCOME minus (-) $20.

c. The amount must be more than or the same as the TOTAL NET UNEARNED INCOME for RRF.

d. The amount must be more than or the same as the RSDI AMOUNT, if entered for RRF.

REVISED 03/01/10 – CHANGE NO. 03-10

II. (CONT'D)

NOTE: WHEN BUDGETING EARNED INCOME FOR AN INDIVIDUAL WHO IS NOT A RECIPIENT, OR FOR AN INDIVIDUAL WHO IS BEING DELETED FROM THE CASE, INCLUDE THE NET INCOME IN THIS FIELD. DO NOT ENTER THIS INDIVIDUAL'S INCOME IN THE INDIVIDUAL INCOME FIELDS.

G. SPECIAL DATA

1. FOOD STAMP NUMBER: This is a seven digit alpha/numeric field.

2. STEPPARENT INDICATOR: This is a one-digit numeric code. See the Code Appendix to determine the appropriate code. (Not applicable to S-AA, S-AD, or S-CD.)

3. GRANDFATHER STATUS: Do not enter.

4. SSI STATUS: Do not enter. (System Generated).

5. VA PAYMENT: Mark "YES" or "NO."

6. SPECIAL REVIEW TYPE: This is an alpha/numeric code. See the Codes Appendix to determine the appropriate special review code. If entered, SPECIAL REVIEW DATE is required.

7. SPECIAL REVIEW DATE: This is a four digit numeric field and must be MMYY. The date must not be before the current processing month.

8. SPECIAL USE CODE: This is a two digit alpha code. See the Codes Appendix to determine the appropriate special use code. If entered, SPECIAL USE DATA is required.

9. SPECIAL USE DATA: This is a twelve digit numeric field. If entered, SPECIAL USE CODE is required. See the Codes Appendix to determine the appropriate special use data. The data must contain the following:

a. The date coverage begins (MMDDYY). The date must be before or the same as the current processing month.

b. The date coverage ends (MMDDYY). The date must not be before or the same as the date coverage begins. The date may be 999999.

REISSUED 03/01/10 – CHANGE NO. 03-10

II. (CONT'D)

H. SPECIAL COVERAGE GROUP DATA (1, 2, and 3)

1. CODE: This is a two digit alpha field. See the Codes Appendix to determine the appropriate special coverage group code. If entered, BEGIN DATE is required.

2. BEGIN DATE: This is a six digit numeric field. The data must contain MMDDYY and must be the first day of the month. This field is required if SPECIAL COVERAGE CODE is entered.

3. END DATE: This is a six digit numeric field. The data must contain MMDDYY and must not be prior to the BEGIN DATE. If entered, SPECIAL COVERAGE CODE and BEGIN DATE are required.

NOTE: FOR FURTHER INSTRUCTIONS, SEE THE APPROPRIATE "SPECIAL COVERAGE" SECTION.

I. INDIVIDUAL DATA

1. INDIVIDUAL ID: The Individual ID number for each individual included in the case is brought forward. You may not key in this field.

2. INDIVIDUAL NAME: The names of all the individuals included on the case. You may not key in this field. Correct the name on the NAME CHANGE screen.

3. SOCIAL SECURITY NUMBER: This is a nine digit numeric field. You may not key in this field. Correct the social security number on the NAME CHANGE screen.

4. INDIVIDUAL TERMINATION DATE: See "Deletion of an Individual."

5. CASE STATUS: This is a one digit alpha field. See the Code Appendix to determine the appropriate case status code.

6. DATE OF BIRTH: This is an eight digit numeric field (MMDDCCYY). You may not key in this field. Correct the date of birth on the NAME CHANGE screen.

NOTE: WHEN CHANGING THE DATE OF BIRTH ON THE NAME CHANGE SCREEN, AND THERE IS A DSS-8125 PENDING FOR AN ACTION OTHER THAN A TERMINATION, YOU MUST FIRST DELETE THE PENDING DSS-8125 BEFORE THE DATE OF BIRTH CAN BE CHANGED. IF YOU ATTEMPT TO CHANGE THE DATE OF BIRTH BEFORE DELETING THE DSS-8125, EIS DISPLAYS THE ERROR MESSAGE - 031: TO MAKE CHANGE ON DOB, YOU MUST DELETE 8125 FORM. KEYING THE DSS-8125 AFTER THE DATE OF BIRTH CHANGE ENSURES THE ACTION PROCESSES THROUGH THE APPROPRIATE AGE EDITS IN EIS.

REVISED 10/01/09 – CHANGE NO. 01-10

II. I. (CONT'D)

7. RACE: This is a one digit alpha field. You may not key in this field. Correct the race on the NAME CHANGE screen.

8. SEX: This is a one digit alpha field, "M" (MALE) or "F" (FEMALE). You may not key in this field. Correct the sex on the NAME CHANGE screen.

9. RSDI CLAIM NUMBER: This is a twelve digit alpha/numeric field. This field is required if RSDI Amount is entered and/or if either Medicare field is marked "Y."

a. A “Z” suffix is not allowed if:

(1) The Medicaid Classification is Q.

(2) The individual is under 65 years of age in the ongoing month.

b. The RSDI CLAIM NUMBER:

(1) Can not be blank or zeroes if the Medicaid Classification code is Q.

(2) Must be the individual’s own Social Security number if the RSDI CLAIM NUMBER suffix is A, M, or T.

(3) Is the individual’s Social Security Number with a suffix of “Z” for an alien who does not qualify for Medicare due to not having five years of residency in the U.S. and who is age 65 or over in the ongoing month. This will allow claims for the alien to bypass Medicare editing.

10. MEDICARE A: Mark “Y” or “N”. If “Y”, the RSDI CLAIM NUMBER is required. Mark “Y”, if the MEDICAID CLASS is “Q”.

11. MEDICARE B: Mark “Y” or “N”. If “Y”, the RSDI CLAIM NUMBER is required.

12. FAMILY STATUS: This is a one digit alpha field. See Codes Appendix to determine the appropriate family status code.

13. LIVING ARRANGEMENT: This is a two digit numeric field. See the Codes Appendix to determine the appropriate living arrangement code. This code must be the same for all individuals on the case.

14. SPECIAL REPORT: This is a one digit alpha field. See the Codes Appendix to determine the appropriate special report code.

15. WORK REGISTRATION: R-RF CASES ONLY. This is a one digit numeric field. See the Codes Appendix to determine the appropriate JOBS/WORK Registration/Exemption code.

REISSUED 10/01/09 – CHANGE NO. 01-10

II.I. (CONT'D)

16. SPECIAL USE CODE: This is a two digit alpha field. See the Codes Appendix to determine the appropriate special use code. If entered, SPECIAL USE DATA is required.

17. SPECIAL USE DATA: This is a twelve digit numeric field. If entered, SPECIAL USE CODE is required. See the Codes Appendix to determine the appropriate special use data.

18. REFUGEE STATUS CODE: This is a two digit alpha field. See the Codes Appendix to determine the appropriate refugee status code. If entered, U.S. ENTRY DATE is required. (Not applicable to SA.)

19. U.S. ENTRY DATE: This is a six digit numeric field. The data must contain MMCCYY. If entered, REFUGEE STATUS CODE is required. The date must be the same for each individual with a refugee status code, not including an essential person. The date must not be greater than eight months before the month of application. (Not applicable to SA.)

20. DATE OF DEATH: This is a six digit numeric field. The data must contain MMDDYY. The date must be before or the same as the current date. If entered the change code must be “52”. If this is the only individual on the case, see "Terminating a Case, EIS 3200."

21. CITIZEN/ID: This is a two digit numeric code field and date (mmddccyy). The date entered cannot be a future date. If the code entered is 50 or 99, the date is the date the DSS-8125 is keyed. For the other codes, the date is when the documentation of citizenship or identity is received. This is not a required field during a change. The code may be changed to another code as outlined below. You must enter a date when changing the CITIZEN/ID code.

NOTE: When a Citizen/ID code 60, 61, 62, 63, 64, 65, or 66 is keyed, a Refugee Status Code/Date is required in the REF CODE / DATE field.

When a Citizen/ID code 60, 61, 62, 63, 64, 65, or 66 is keyed, an Alien ID number is required in the ALIEN ID field.

REISSUED 02/01/11 – CHANGE NO. 03-11

II.I. (CONT'D)

10 overlays 25, 35, 45, 50, or 99

25 overlays 35, 45, or 99

35 overlays 45 or 99

45 overlays 99

50 overlays 25, 35, 45, or 99

99 can be overlaid by 51 and 60-66

51 and 60-66 can be overlaid by any code

50 can be overlaid by 51 and 60-66

Code 51 Lawful Permanent Resident

Code 60 Refugee status and identity

Code 61 Asylee status and identity

Code 62 Cuban / Haitian status and identity

Code 63 Amerasian status and identity

Code 64 Trafficking Victim status and identity

Code 65 “SI” (Special Immigrant) status and identity

Code 66 “SQ” (Special Immigrant) status and identity

22. ALIEN ID: This is an eight to thirteen digit alpha/numeric identification/file number assigned to every alien who is admitted into the US or who otherwise comes into contact with the agency.

23. Enter the RELATIONSHIP TO PAYEE code. See Codes Appendix to determine the appropriate code.

24. SPECIAL NEEDS: This is a one digit numeric field. See EIS 4000 for codes.

25. E&T: Do not enter.

26. JOBS/WORK REQUIREMENT SAVINGS REASON: Do not enter.

27. JOBS/WORK REQUIREMENT SAVINGS AMOUNT: Do not enter.

28. ED. EMPL: Do not enter.

29. GROSS EARNED INCOME R-RF CASES ONLY. This is a five digit, numeric, dollars and cents field.

30. WORK EXPENSES: This is a five digit, numeric, dollars and cents field. If entered, the amount must be 09000.

31. CHILD/ADULT CARE: This is a five digit, numeric, dollars and cents field.

REVISED 02/01/11 – CHANGE NO. 03-11

II.I. (CONT'D)

32. NET EARNED INCOME: This is a five digit, numeric, dollars and cents field.

33. EDUCATIONAL LEVEL: Do not enter.

34. ISSUE CRD: Do not enter.

35. EPICS CLAIM INDICATOR: Do not enter.

36. CAROLINA ACCESS: Enter the appropriate number.

J. Supplemental Notice Information (S-AA, S-AD, and S-CD Only. Not applicable to R-RF).

The following three data elements have been added to the DSS-8125 Data Entry screen. A change code must be present in order to enter these fields. A recommended form in which to enter the information can be found at the end of this section. This form must be attached to the DSS-8125 when submitting to Data Entry for keying.

1. Enter the AUTHORIZED REPRESENTATIVE/CAP MANAGER/PACE AGENCY'S NAME and ADDRESS if one has been appointed to the case. An automated notice will be produced for both the payee and the authorized representative/CAP Manager or PACE Agency.

2. Do not enter NOTICE CODE.

3. Do not enter NOTICE TEXT.

III. 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.

IV. Key THE DSS-8125.

V. OUTPUTS

A. Case Profile

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