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. This is a form to be completed by staff – not providers or customers.
The following would be reasons to submit an EBT-4:
- Copay correction for a prior month/s
- Unit Type / Unit Number correction for prior month/s
- Date-of-birth correction
- Pending TAP transactions over 90 days
- Determine if the incorrect payment was caused by a case issue, or by provider or client error
- An EBT-4 would be used in the event of a case issue, otherwise the provider would need to follow their manual claim process
- 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 01/01/2026 01/17/2026 02/01/2026 02/21/2026 03/01/2026 03/21/2026 04/01/2026 04/18/2026 05/01/2026 05/16/2026 06/01/2026 06/20/2026 07/01/2026 07/18/2026 08/01/2026 08/15/2026 09/01/2026 09/19/2026 10/01/2026 10/17/2026 11/01/2026 11/21/2026 12/01/2026 12/19/2026 Refer to article Child Care Subsidy: How to Submit an EBT-4
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