Information to record in each applicable FACS tab of the Interview Notebook during an SNAP application or review interview or prior to taking action on an application or review includes:

Case Information Tab:

• Describe the type of action being processed (EO, SEO, MCR, Change, etc.)
• Document interview date – include special circumstances (waived interviews)
• Document who was interviewed
• Document EO Screening – enter date and EO determination and amount of liquid resource (if available)
• Document that the client was informed of Rights and Responsibilities and QC process at every application or certification renewal.
• Document Verification Requested: Document what verification has been requested (For MCR, list verification that is pending). List items in enough detail that someone else would be able to process the case or answer any questions. Document if no further verification was needed.

Typical case info notes will include, but are not limited to:

1. SNAP app/renewal/change submitted on 00/00/00. Phone interview conducted 00/00/00 with Mary. EO screening completed on 00/00/00 and household is/is not EO eligible. Rights and Responsibilities and QC Process discussed and understood.AMD-92 issued on 00/00/00 requesting ______.
2. SNAP MCR received 00/00/00, screened for completion. Income verification for X employer still needed.

Household Tab:

• Document the household composition and who is included in the benefits.
• Explore and document all special circumstances* and program eligibility as applicable for each household member:
  • Citizenship/alien status
  • Separate Household status (describe relationships of others in household)
  • Student status
  • Fleeing Felon
  • Receipt of commodities
  • Moved/ received benefits from another state within the last 12 months
  • Disqualified household members

Typical household notes will include, but are not limited to:

1. Household of 4, all included in the SNAP benefit.
2. Household of 4 with three members included in the SNAP benefit, Mary is a full time college student, all student exemptions explored. Mary is an ineligible student.
3. Household of 2. All members included in the SNAP benefit. Household received SNAP benefits in Texas for the month of _____, worker verified via phone call that Texas benefits closed effective 00/00/00.

Income Tab:

Earned Income

• Address and document income showing on data exchange screens as applicable per case action (ACES/OWL/NHL), information reported on PS-1 or LIVE, and status of previously reported income.
• Explore and document employment status for all potentially employable household members, including name of employer, start date and pay frequency (for new employment)
• Explain how income was verified and calculated, which checks were included and which were excluded and why. Copy and paste MICAL.Include documentation of special circumstances* as applicable such as:
  • New Employment
  • Actual Income
  • Change in rate of pay
  • Bonus Income
  • Special Pay (Benefit allowance, per diem, military, school employment)
  • Medical leave (Maternity leave, temporary disability)
  • Student status for employed minor
  • Employment terminated in the last 3 months (provide date of final check)
• If a household member is self-employed, document month and year the self-employment began (if it was not addressed in a prior case action) and whether tax forms/ledgers are available. Explore and document business expenses.

Typical earned income notes will include, but are not limited to:

1. John is still working at ______. Client provided the following pay stubs, all checks are representative and are included in the calculation.MICAL:
   00/00/00 $00.00
   00/00/00 $00.00
2. John is employed at ______, start date 00/00/00, pay rate is $00.00, he is paid bi-weekly, on Fridays. Client provided the following pay stubs:00/00/00 $00.00 Partial Check- Not representative, not included
   00/00/00 $000.00 First full pay period, check used to anticipate income000.00*2.15 = $000.00
3. John stated that he is self-employed as a _____ and declared business expenses. He started his business 00/00/00. He provided ledgers for _____ through _______.Month $00.00
   Month $00.00Total 00.00/2 = $00.00 ½ Business Expense = $00.00

Unearned Income

Address and document unearned income showing on data exchange screens (TANF, Child support, UIB, RSDI, SSI, SSP and foster/adoption payments), information reported on PS-1 or LIVE, and status of previously reported unearned income. Include explanation of garnishments and overpayments.

• Explore and document other unearned income sources for all household members such as:
  • Veteran’s Benefits
  • Worker’s Comp
  • Rental Income
  • Contributions
  • Royalties and Dividends
  • Tribal Income
  • Pension
• Describe how income was verified and calculated.

Typical unearned income notes will include, but are not limited to:

1. Client receives $000 RSDI verified by BEN screen; BEN screen shows a $00 recoupment.
2. Client receives regular bi-weekly child support of $000 by wage assignment, income verified by Ki1 screen. 000 x 2.15 $000/month
3. Client receives irregular child support verified by Ki1 screen, average the last 2 full months (____ and _____) = $00.00/month. Large payment on 00/00/00 was federal tax garnishment and is not included as it is a non-recurring lump sum.

ABAWD Tab:

• List Work Registration exemptions for each household member.
• List ABAWD exemptions for each household member. If no exemption is met document that all exemptions were explored.
• If ABAWD and not exempt or meeting the work rule, check for previous K months to determine eligibility and document which months are now countable, and if the household member may have regained eligibility.
• If ABAWD eligibility requires verification, document how eligibility was verified.

Typical ABAWD notes will include, but are not limited to:

1. Carol and Butch are ABAWD exempt – minor children in the household. Seth and Sage are exempt – under 18.
2. Butch meets no ABAWD exemptions and countable K months will be ___, ____, and _____ 2017.
3. Joe meets no ABAWD exemptions. He has already received his 3 “K” months and has not regained eligibility.
4. Ron meets no ABAWD exemptions; he is working 20 hr/week. He has not received previous K months.
5. Worker reviewed ABAWD Rights and Responsibilities with Carl

Expenses Tab:

• Explore, document any allowable expenses reported by client or showing on case record, exchange screens or pay stubs (dependent care, medical for elderly/disabled and child support paid outside the home)
• Document proration of expenses
• If expenses were not identified, document that potential expenses were explored.
• Describe how expense was verified (if applicable) and calculated.

Typical expense notes will include, but are not limited to:

Dependent Care

1. Client’s day care copay through DHS is $00/mo.
2. Client’s day care copay through DHS is $00/mo., pro-rated to $00/mo for 2 out of 4 eligible HH members.
3. Client reports she pays $00/wk to her sister for child care for Susie and Joe
   $00.00 x 4.3 = $000/ mo

Medical

1. No medical expenses declared for elderly/disabled hh members.
2. Client pays $105 Part B premium verified by BEN screen.
3. Client declares medical expenses of $000/month for Mark. Provided verification of a $00/mo Medicare Supplement policy and $00/mo dental premium. Medical deduction of $000/mo given.

Child Support

1. Lee pays $00 bi-weekly child support verified by CFRRPA screen $00 x 2.15 = $000/mo.
2. Bob pays $000/mo child support verified by money orders for the months of ___ and ____. Divorce decree shows court ordered amount is $____. $____amount will be given as deduction.
3. Sue pays $00 bi-weekly child support verified by garnishment from checks provided $00 x 2.15 = $000/mo.

Shelter Tab:

• Determine and document if client pays rent or mortgage, and if mortgage includes property taxes and insurance. Document if client is receiving help (ex.HUD) or sharing costs with someone outside the household.
• Explore and document utility expenses (including if utilities are paid by someone else.) If no utility expenses, document that telephone allowance was explored.
• Document proration of shelter cost if applicable.

Typical shelter notes will include but are not limited to:

1. Client declares she pays $000/month mortgage, which includes property taxes and insurance. Client is responsible for heating /cooling cost.
2. Client declares rent of $000/mo, all bills paid. Receives HUD assistance and her portion is $00. Pays telephone only.

Remember!

Document any phone conversations used for verification. Provide the name and contact number of the verifier, and detail what information was provided.

Examples:

1. Spoke to John Smith (405-567-1234) at _____ employer. Verified Mary is no longer employed and received final paycheck 00/00/0000.
2. Called Jacob (918-234-5678) to confirm monthly cash child support payments of $000 total for both children.

Explain any discrepancies between information received on documents provided and/or information stated by the client verbally and/or information showing on the case.

Examples:

1. During interview, John declared he pays $500/month in rent and that he is responsible for heating and cooling cost. LIVE renewal lists rent as $400, which he stated was a typo.
2. OWL shows employment at _____. During the interview, Mary did not report she was working; when asked she stated she only worked there one week.

**Special Circumstances: Worker must explore special circumstances with client, but documentation of special circumstances is only required if applicable. For more information on how to explore and document special circumstances refer to SNAP Policy, Quest, and/or Eligibility Handbook for SNAP.