Instructions: Pre-Entered in application registration process. This number serves as a unique identifier for this case. The prefix designates financial assistance and/or social services. Case number prefixes are as follows:

• A = State Supplement to the Aged.
• B = State Supplemental to the Blind.
• C = Family Case – including TANF.
• D = State Supplement to the Disabled.
• E = Assistance payments or medical Services for refugees.
• H = Family case – including T
• N = Energy Assistance.
• S = Food benefits.
• W = Adult Protective Services only.
• Z = Emergency TANF payments / Family Services.

Instructions: Pre-entered in application registration process. Indicates the name of the individual coded C, G, or P in Block F9. When the payee (F9) changes, the case name will be automatically updated.

Instructions: Enter the number of the county of service. For counties 01-09, enter only 1-9 (“00” for state office use only).

Instructions: Entered by the computer except for counties with multiple offices. Enter the appropriate alphabetic code.

Instructions: Enter the supervisory group number to which this case has been assigned.

• 1 = County Director.
• 2-90 = County Supervisors.
• 91-99 = State Office Use Only.

Instructions: Enter the number (1 through 99) of the employee to whom this individual case has been assigned.

Instructions: Enter appropriate code to reflect a language barrier. Code Y will automatically be assumed by the computer unless code A, N, or S is entered. This code is also used for EPSDT personal contacts and will be transmitted to the Oklahoma Health Care Authority for medical assistance information.

• A = Adults speak but cannot read or write English – personal contact is required.
• N = No English speaking adult – personal contact is required.
• S = Adults speak and can read or write Spanish – personal contact is required.
• Y = Adults speak and can read or write English – personal contact is not required.

Instructions: Enter the client’s telephone number or a telephone number where the client can be contacted.

Instructions: Enter appropriate code for telephone number shown in A19

• H = Home.
• C = Cell.
• F = Friend.
• N = Neighbor.
• O = Other.
• P = Pager.
• R = Relative.
• W = Work.

Instructions: Enter the code to indicate the household’s shelter type. Codes A through D are used to indicate shelter arrangements for homeless individuals only.

• A = Homeless – Emergency or transitional shelter.
• B = Homeless – Temporarily lives in motel, hotel, or campground due to no alternative accommodations for less than 90 days.
• C = Homeless – Temporarily lives in the residence of another person due to loss of housing, economic hardship, or similar reason for less than 90 days.
• D = Homeless – Place not designed for, or ordinarily used as, an accommodation for human beings (car, park, public space, abandoned building, substandard housing, bus or train station, or similar place).
• F = Receives rent subsidy from HUD or any government agency.
• H = Voluntarily shares shelter with another household to reduce expense. (Not considered homeless).
• M = Owns home and has mortgage payment.
• N = Owns paid-off home.
• O = Other (not considered homeless). For example, nursing home, assisted living center, mental hospital, prison, etc.
• R = Renter – receives no subsidy.
• X = No shelter expenses (includes renters or home owners whose rent or mortgage is paid by non-household members).

Instructions: Mailing Address. Enter the street address, box number or rural route for receiving mail using the following abbreviations:

• Apartment = Apt
• General Delivery = Gen Del
• Avenue = Ave
• Lane = Ln
• Boulevard = Blvd
• Lot = Lt
• Circle = Cir
• Place = Pl
• Cluster Box = CL
• Box Post Office Box  = PO Box
• Court = Ct
• Road = Rd
• Diagonal = Diag
• Rural Route = R R
• Drive = Dr
• Street = St
• Expressway = Exp
• Terrace = Ter

Instructions: Enter the city of the mailing address.

Instructions: Enter the state code of mailing address.

Instructions: Enter the zip code of mailing address

Instructions: Guardian, substitute payee, conservator, authorized representative, other responsible person, or extra address. If applicable, show name of applicant or recipient’s guardian, substitute payee, authorized representative, conservator or other responsible person. Enter first name, middle initial and last name.
This space may be used for an extra line of address. The entry should be that part of the address that immediately follows the name.
If a two-party check will be issued, use this space to shown name of the joint party (utility company, landlord, etc.).
If a check is to be issued that will be cashed only by the vendor, use this space to show the name of the vendor.
For DHS custody children, shown the DCFS worker’s name and county number. For IV-E and state option adoption subsidy children, show the state from which adoption subsidy is paid.

Instructions: Indicator. If an entry is made in Block A32, enter the appropriate alphabetical code.

• B = State Option Adoption Subsidy.
• C = Conservator.
• D = State or Tribal custody.
• E = Designated IV-E Medical Care.
• G = Legal guardian.
• H = Natural guardian.
• O = Other responsible person.
• R = Authorized representative for Food benefit Electronic benefits.
• S = Substitute Payee – TANF only.
• T = Two-party check – category Z only.
• U = Z check made payable to vendor – mailed to vendor.
• V = Voluntary placement of child.
• X = Extra line of address.
• Z = State or Tribal custody children for whom no medical ID should be issued due to out-of-state placements.

Instructions: Enter the finding street address where client can be located. In rural areas where street address is not available, this block may be left blank.

Instructions: Enter the city of client’s finding address

Instructions: Enter the state of the client’s finding address

Instructions: Enter zip code of finding address

Instructions: Property Indicator. Use the following codes to indicate any special conditions which exist in relation to the property.

• F = Federal relocation funds
• H = Homestead right only
• I = Restricted Indian property
• L = Life estate
• N = Owns home but indicators F, H, I, L not applicable
• O = Other Real Property

Instructions: Property Value. Enter the total market value if property is owned or being purchased. On Indian Mutual Self-Help Housing enter the total market value, if any, of land associated with the home after the land on which the house is located has been deeded to B.I.A.

Instructions: Property Equity. Enter the total equity of the property valued in Block A43 owned by any person in this case or combination of persons included in this case. If the home was purchased with Federal Relocation Funds, enter the amount of equity excluding the Relocation payment. On Indian Mutual Self-Help Housing, enter the equity in the home property excluding the acre or lot deeded to B.I.A. If no equity, enter zero.

Instructions: Property – Lots or Acres. Enter the number of lots or acres included in all property rounded to the nearest lot or acre. Designate lots by showing an L suffix; designate acres by showing an A suffix; enter R for home or trailer located on land not owned by the client or other person in this case.

Instructions: Property – Percentage of Ownership. Enter the total percentage or interest in any property owned by client(s).

Instructions: Primary Language Spoken indicator. Enter the appropriate code to indicate what language is primarily spoken by the family at home.

• 1 – English
• 2 – Spanish
• 3 – Native Central, South American, and Mexican languages (e.g., Mixteco, Quichean)
• 4 – Caribbean Languages (e.g., Haitian-Creole, Patois)
• 5 – Middle Eastern and South Asian Languages (e.g., Arabic, Hebrew, Hindi, Urdu, Bengali)
• 6 – East Asian Languages (e.g., Chinese, Vietnamese, Tagalog)
• 7 – Native North American/Alaska Native Languages
• 8 – Pacific Island Languages (e.g., Palauan, Fijian)
• 9 – European and Slavic Languages (e.g., German, French, Italian, Croatian, Yiddish, Portuguese, Russian)
• 10 – African Languages (e.g., Swahili, Wolof)
• 11 – Other (e.g., American Sign Language)
• 12 – Unspecified (unknown or head of household declined to identify home language)

Instructions: Enter companion and cross reference case number pertinent to the entire case. Companion cases are those cases where eligibility determination is dependent on the eligibility conditions in both cases.
Cross reference cases are those which contain information about individuals in this case, but eligibility of one is not dependent upon eligibility of the other.
When Title XIX cases are certified or closed because of a transfer between categories, the case number closed is shown as a cross reference on the certified case, and the case number certified is shown as a cross reference on the closed case. In both instances, the cross reference number is shown with a preceding asterisk (e.g., *D123456).

Refer to FACS: Companion Coding

Instructions: Indicator. Enter appropriate code to indicate the type of companion/cross reference number indicated in the two preceding blocks.

• B = Both financial assistance and SNAP companion cases.
• F = SNAP companion case.
• M = Medical companion case.
• P = Financial assistance companion case.
• R = Cross reference only.
• X = Case number before computer renumbered – computer-entered only.

Refer to FACS: Companion Coding

Instructions: Enter the county in which the client lives.

Instructions: Enter the office location.  This will be C unless the client lives in Oklahoma, Tulsa, or Cleveland county.