Child Care Subsidy: UpdatedWhen to Submit an EBT-4

An EBT-4 is a form to make payment adjustments to providers when incorrect case information is transmitted to EPPIC and the provider is paid incorrectly.

  1. Determine if the incorrect payment was caused by a case issue, or by provider or client error
  2. An EBT-4 would be used in the event of a case issue, otherwise the provider would need to follow their manual claim process
  3. Use the chart to determine if an EBT-4 is required based on the date the case was corrected and the effective date of change
    Effective Date of Change EBT-4 Required if Change is Made on or After This Date
    01/01/2021 01/15/2021
    02/01/2021 02/19/2021
    03/01/2021 03/19/2021
    04/01/2021 04/16/2021
    05/01/2021 05/14/2021
    06/01/2021 06/18/2021
    07/01/2021 07/16/2021
    08/01/2021 08/20/2021
    09/01/2021 09/17/2021
    10/01/2021 10/15/2021
    11/01/2021 11/19/2021
    12/01/2021 12/17/2021
  4. Confirm that an authorization is on the system for the time period you want to cover
  5. Confirm the appropriate changes are made in the system effective the 1st day of the current month
  6. Submit completed form to the EPS staff by clicking “Submit” at the bottom of the formEBT-4 form with the Submit button highlighted

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