The benefit issuance schedules for Temporary Cash ...



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|Department of Human Resources | |

|311 West Saratoga Street |FIA INFORMATION MEMO |

|Baltimore MD 21201 | |

|Control Number: 00-32 |Effective Date: February 1, 2000 |

| |Issuance Date: January 4, 2000 |

TO: DIRECTORS, LOCAL DEPARTMENTS OF SOCIAL SERVICES

DEPUTY/ASSISTANT DIRECTORS FOR FAMILY INVESTMENT

FAMILY INVESTMENT SUPERVISORS

FROM: ROBERT J. EVERHARD, EXECUTIVE DIRECTOR, FIA

RE: OBSOLETE FORMS

PROGRAM AFFECTED: ALL PROGRAMS

ORIGINATING OFFICE: OFFICE OF POLICY, RESEARCH AND SYSTEMS

The Family Investment Administration (FIA) worked with the Standing Policy Committee, Fiscal Unit, and DHMH to develop the attached obsolete form list. Due to the changes that came along with the Family Investment Program (FIP), these forms no longer adequately meet the needs of DHR’s programs, policies and procedures.

The forms will become obsolete effective February 1, 2000. If you have any questions or concerns, please contact Fatmata Khella at 410-767-7585.

Attachment: list of obsolete forms

cc: DHR Executive Staff DHMH Executive Staff

FIA Management Staff DHMH Management Staff

Constituent Services FIA Program Analysts

OBSOLETE FORMS LIST

AS OF FEBRUARY 1, 2000

DHR/IMA FS 1 Application for Food Stamp – Part 1

DHR/FIA AIMS 1 Screening/Inquiry form

DHR/FIA AIMS 1X Screening /Inquiry form

DHR/FIA AIMS 2X Transaction Type – Public Assistance

DHR/FIA RAP2 Notification of Application for Refugee MA Assistance

DHR/FIA AIMS 2.3C Alternate Case Information

DHR/FIA AIMS 7 Public Assistance OTO Authorization

DHR/FIA AIMS 8 Public Assistance Manual Issuance Authorization Form

DHR/IMA AIMS 9 Public Assistance Check Status Change Form

DHR/FIA AIMS 10 Public Assistance Manual Issuance Form

DHR/FIA AIMS 11 Food Stamp OTO Authorization

DHR/FIA AIMS 12 Food Stamp Manual Issuance Form ATP/ATI

DHR/IMA AIMS 13 Food Stamp ATP/ATI Status Change Form

DHR/FIA AIMS 14 Food Stamp Manual Issuance Completion Form

DHR/FIA AIMS 15 Establish Cash Record for EA/EAFE

DHR/FIA AIMS 24 EAFC Issuance Correction Form

DHR/IMA 59 Spend Down Activity Form

DHR/FIA AIMS 103 Division of Data Processing

DHR/IMA 103C Supervisory Review System

DHR/IMA AIMS 153 Request for AIMS PA Check/ATI Cards

DHR/IMA 154 Benefit Inventory Control

DHR/FIA AIMS 155 Stop Payment Request Public Assistance Checks

DHR/FIA AIMS 156 Manual Issuance Daily Tally Sheet – Authorization to Issue

DHR/IMA AIMS 157 Notice of Receipt of Refund

DHR/IMA AIMS 158 PA Overpayment, Recoupment and Refund Record

DHR/IMA AIMS 159 PA Overpayment, Recoupment and Refund Record

DHR/FIA AIMS 174 AIMS Report Packing List

DHR/FIA AIMS S-200A Information for AFDC & FS Clients

DHR/FIA AIMS S-200B Procedures for Fair Hearings

Des 203 Notice of Medicare Beneficiary’s Change in Elig. Status

DHMH 206N Long Term Care Transaction Form

DHR/IMA 369 Verification of Earnings

DHR/IMA 370 Verification of Benefits/Unearned Income

DHR/IMA 371 Verification of Resources/Assets

DHR/IMA 372 Income and Resource Letter

DHR/IMA 373 Income and Resource Letter

DHR/IMA RAP 533 Notice of Decision – RCA

DHR/IMA 534 Notice of Action during Payment Period – RCA

List of obsolete forms (effective 2/1/2000) continues:

DHR/IMA 535 Reminder to Recipients of RCA

DHR/IMA 747 Medical Assistance Extension – Child Care Report

DHR/IMA 1100 Abbreviated Eligibility worksheet – P.A./ Food Stamp

DHR/IMA 1101 Abbreviated Eligibility Worksheet – Medical Assistance

DHR/IMA 1103 AFDC, AFDC-UP, GPA-PW, RCA Calculation worksheet

DHR/IMA 1105 GPA/GPA-E Calculation Sheet

DHR/IMA 1106 PAA Domiciliary Care and Project Home Calculation Sheet

DHR/IMA 1107 PAA DHMH Rehabilitative Residence Calculation Sheet

DHR/IMA 1109 Medical Assistance State Only Calculation Worksheet

DHR/IMA 1110 Medical Assistance Deemed Income Calculation Worksheet

DHR/IMA 1111 MA Spend Down Eligibility Determination

DHR/IMA 1112 Motor Vehicle Resource Computation

DHR/IMA 1113 Life Insurance

DHR/IMA 1114 Countable Resource

DHR/IMA 1116 30 1/3 Tracking Sheet

DHR/IMA 1117 Disqualification Tracking Sheet

DHR/IMA 1118 Lump Sum Tracking sheet

DHR/IMA 1119 Unemployed Parent Determination Sheet

DHR/FIA 1125 Health OTO Tracking Form

DHMH 1158 D-1 PWC – Checklist For Medicaid Applicants

DHMH 1159E Eligibility Determination Worksheet

DHMH 2583 Insurance Reporting Form

MAPA 1 Notice of Determination of Presumptive Eligibility

MAPA 9 PWC Program

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