Special Assistance SA3410f6

STATE/COUNTY SPECIAL ASSISTANCE FOR ADULTS MANUAL SA-3410

Figure 6 – Payment Record

RECIPIENT FRAUD
Name					Telephone
Address
Co. Case #		Case ID		District #		Total Due
1. Referral Pending			Court Disposition			Board Disposition
2. Summaries to be Submitted			1. Guilty			1. Repay
3. Awaiting Action			2. Judgement			2. Conditions of Repayment
4. D.A Referrals			3. Not Guilty			3. No Action
5. Awaiting Prosecution			4. Pending			4. Pending

6. Summons Signed
7. Trial Scheduled		PAYMENT RECORD
		Date	Payment	Balance	Date	Payment	Balance
8. Resubmitted to Board
9. Trial Held
10. Agreement to be Signed
11. Repayment
12. Obligated not Paying
13. Closed Fraud Case

SA-3410 – Figure 6