Instructions: Pre-entered by computer when PS-1B, Case Number Assignment, is used to request Financial Assistance.
In all other instances, enter the date of oral request or the date the client signed the application for Financial Assistance, whichever came first, provided the applicant signed the application within 30 days of the verbal request.See Public Assistance Procedures:

Definitions “Date of Application” 340:65-3-2

Instructions: Enter month, day and year if the current certification for financial assistance.

See Public Assistance Procedures: Definitions Certification for Cash Assistance 340:65-3-5(3). This should either be the date the client applied or if they were not eligible in that month, the first day of the next month.

Instructions: Enter the appropriate code for action taken on financial assistance cases. This block must be completed each time new information is submitted.

1

= Certified

2

= Denied

4

= Suspended (ABD/SSP Only)

5

= Reinstated

6

= Closed

A

= Application

C

= Any change of information which does not affect section status

F

= Certified for IV-E Foster Care only

M

= Certified for Special Medical Benefits (ABD only)

R

= Reopened – This code is used to reopen a case closed in error or when eligibility has been re-established within the allowed time frame.

Instructions: Enter the appropriate reason code as shown on Appendix R and U for action type 1,2,4,6,F,M,or S. This block may be updated, but is not to be deleted.

Appendix R

Appendix U

Instructions: Computer determines and enters the effective date using information from blocks B1, B2, B3, B9, the benefits data base, and Appendix B-2 for all actions except reinstatements and closure for the reason of death. For reinstatements, enter the effective date for which benefits are being reinstated. For certifications following an appeal or to correct an administrative error, the effective date is the first month for which benefits are to be paid and may be a retroactive date.  For closures due to death, enter the date the death occurred.

Instructions: At certification, the computer enters code 99 unless worker enters one of the following codes to show that information needs to be updated for the next issuance to be correct. Codes are:

1

= Issue one month’s benefits based on the information currently on the case.

2

= Issue two months’ benefits based on the information currently on the case.

3

= Issue three months’ benefits based on the information currently on the case.

99

= Benefits will be based on the information currently on the case indefinitely until updated again.

When a code from 1 through 3 is used, the case status will be “unfinished” until code ‘99’ is entered or the section is closed.  If Section B should be closed in unfinished status, do not change the entry in this block.

Note: All retroactive certifications must use the unfinished issuance process.

Instructions: Enter the date of the most current eligibility re-determination.

• for Certifications this will be the same as the cert date
• for Reviews this date will be the next effective date

See Public Assistance Procedures: Determination of continuing eligibility 340:65-3-8.

Instructions: After first deadline through second deadline, enter code to show whether advance adverse action notice is required for change being made or closure of benefits.

Y

= Ten day advance notice is required.

N

= Ten day advance notice is not required.

NOTE:  Once entered, information can be changed, but not deleted, by the user.

Instructions: Computer enters the number of children included in this benefit based on information in Section F.

Instructions: Computer enters the number of children included in the case benefit on information in Section F.

Instructions: Computer will enter the total amount of countable equity in resources for the case from Section F.

Instructions: Enter the source of the Financial Assistance application:

CO

= County Office

LV

= OKDHSLive! (entered by system if application is received through ODKHSLive!)

Note: This field should be updated any time the Financial Assistance section is put into application status. If the application is received via OKDHSLive!, the system will set the value to “OKDHSLive!” (LV).

Instructions: Entered by State Office.

D

=10% Recoupment, Willful misrepresentation

E

=10% Recoupment, Willful misrepresentation and signed affidavit

G

=10% Recoupment, Willful misrepresentation and Lien

J

=5% Recoupment, Agency Error

V

=10% Recoupment, Inadvertent client error

X

=Last Recoupment Payment; amount coded in Block B23
BLANK indicates no overpayment

Instructions: Entered by computer or from the State Office update. Amount shown will indicate amount recouped for the FIN ASST overpayment.

Instructions: For TANF Emergency Assistance (Category Z), enter the amount of emergency payment authorized. Computer will enter amount for all other categories.

Instructions: Computer will enter total case income from all sources of self-employment using information from Section F.

Instructions: Computer will enter total of all gross earned income for this section using information from Section F.

Instructions: Computer entered to reflect total amount of allowable work related expenses for this case using information from Section F.

Instructions: Computer will enter total amount of dependent care expense from information shown in Section F (‘C’ benefit only).

Instructions: Computer will enter total amount of exempt earned income using information from Section F (‘C’ benefit only).

Instructions: Computer will enter total amount of net earned income for this case from Section F.

Instructions: Computer will enter total amount of gross unearned income for this case using information from Section F.

Instructions: Computer will enter total amount of general income exclusion for this case using information from Section F. (ABD benefit type only.)

Instructions: Computer will enter the total amount of diverted income using information from Section F.

Instructions: Computer will enter the total amount of program violation penalties using information from Section F.

Instructions: Computer will enter total amount of net income using information in Blocks B47, B50, B53 and B57.

Instructions: Computer will enter the total requirements for this case.

Instructions: Computer will enter the amount of benefit for which case is entitled prior to recoupment.

Instructions: Enter the appropriate code that indicates why case is in special medical status.

A

= AB or D recipients (who are at least 18 years of age) who have become ineligible for an SSP due to receipt of or increase in RSDI child benefits which are based on their own disability.

B

= Disabled individual who retains Medicaid eligibility under Public Law 96-265, who would be ineligible for SSI benefits due to earnings.

C

= An individual who retains SSI eligibility due to participation in a program to achieve self support.

D

= Individual under age 65 who retains Medicaid eligibility, but loses State Supplemental Payment (SSP) eligibility due to receipt of RSDI on the basis of being a widow or widower.

P

= Aged or disabled individual who retains Medicaid eligibility, but loses State Supplemental Payment (SSP) eligibility due to the RSDI cost-of-living adjustment. (Pickle cases).

S

= Individual who loses State Supplemental Payment (SSP) eligibility due to reduction in the SSP Maximum Payment Standard.

W

= Individual under age 65 who retains Medicaid eligibility, but loses State Supplemental Payment (SSP) eligibility due to receipt of RSDI on the basis of being a disabled widow or widower.

See Medical Assistance for Adults and Children: Related to ABD 317:35-7-38(3)

Instructions: (ABD Only). This block is used for an individual(s) who was approved for nursing care as of December 1973 and retains eligibility for mandatory supplemental payment. When the benefit type changes due to the individual becoming 65 (B or D to A), the worker enters 50 to show the 12-73 requirements.

See Public Assistance Procedures: SSP Eligibility for payment 340:15-1-5(a)(4)

Instructions: Enter the first month/year of TANF ineligibility.  Enter month, century and year mm/ccyy
(EX: 12/2001)To be eligible for the TANF adjustment period, the client must marry or the absent parent returns home if they are already married.

Instructions: Enter month, century and year of the last month of eligibility for adult TANF pending reunification (MM/CCYY)

Instructions: Computer determines and enters the number of children with a “TANF -Supported Permanency” (CK) Benefit from the Household Tab (Section F)

Instructions: Computer enters the total net earned income based on information from the Income Tab (Section F)

Instructions: Computer enters the total net unearned income based on information from the Income Tab (Section F)

Instructions: Computer enters the total net income based on information from the Income Tab (Section F)

Instructions: Computer enters to total amount of program violation penalties based on information from Household Tab (Section F)

Instructions: Computer enters the benefit amount.

Instructions: Computer enters the total requirements for this benefit.

Instructions: When a TANF household qualifies for the TANF Earned Income Disregard, the computer enters the amount to be disregarded for up to three months.

Instructions: Enter the date the client began the employment or self-employment that qualifies the case for the TANF Earned Income Disregard.  If the client’s income has increased from ongoing employment or self-employment, enter the date the increased earnings were initially received.

Instructions: Enter the next effective date from the date in B107 for a negative action per Appendix B-2 Deadlines for Case Actions.