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
    12/01/2023 12/15/2023
    01/01/2024 01/19/2024
    02/01/2024 02/16/2024
    03/01/2024 03/15/2024
    04/01/2024 04/19/2024
    05/01/2024 05/17/2024
    06/01/2024 06/14/2024
    07/01/2024 07/19/2024
    08/01/2024 08/16/2024
    09/01/2024 09/20/2024
    10/01/2024 10/18/2024
    11/01/2024 11/15/2024
    12/01/2024 12/20/2024
  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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