This section illustrates the appropriate location of materials kept in the case record including the application, various forms, and verification materials.  All documents dated within last three years must be maintained.  Do not purge case records without supervisory authorization.

 

 

TANF/Power Cases (Notices and Forms Should Be Filed Accordingly)
Section One    Preliminary Assessment Photo ID Referral Token Receipt Form Voter Registration EBT Referral Form	Section Two MEAE Printout TANF Work Activity Referral Medical/MRT Packet (856,854,1020) Referral to RSA Referral to APRA FSET-1 495 Authorization for Investigation Referral for Domestic Violence 1673A Third Party Liability 1673B Notice of Potential Medicaid Payment Recovery Presumptive Eligibility Forms Report of Non-compliance with TANF Requirements FSET-3
Section Three Generic Application/CADAddendum Food Stamp Expense Addendum 1052 Record of Case Action 1400 Notice to Applicant Generic Recertification Form Food Stamp Penalty Warning 26 Expedite Form	Section Four Rental Vendor Payment Food Stamp Change Report Form Periodic Reports Cap 1/Cap 2 Printouts 1747 Fs Claim Report 726 Report of Overpayment Approval/Denial Notices Adverse Action Notices Benefit Change Notices
Section Five 1288 Notice to IV-D 1348 Request for Hearing 886 Information Exchange UCB Printout(s) Request for Bms Investigation SSI, DMV, BENDEX Printouts Report of Investigation IV-D Partnership Agreement Printout of Child Support Noncompliance Alert	Section Six  Verifications For: Age/Relationship Enumeration Living With Child Care Residency/Shelter Cost Earnings/Unearned Income Resources 1503 Redetermination of Eligibility 1549 School Form 1049 Verification of Vital Event Receipt of Application for SSN Application Checklist

 

 

Medicaid-only Cases (Notices and Forms Should Be Filed Accordingly)
Section One Generic or D.C. Healthy Families Application 1052 Record of Case Action Cad Addendum Generic Recertification Checklist 1209 Recertification Form 1288/a Notice to IV-D Presumptive Eligibility Form(s) 1673A Third Party Liability Form 495 Authorization for Investigation 1400 Notice to Applicant 1673B Notice of Potential Medicaid Payment Recovery	Section Two Recertification Packet Disposition Notice Interface Printout(s) Income Verification Asset Verification Application Packet Disposition Notice Interface Printout Income Verification Medical Bills Non-Financial Verifications Medical/MRT Packet (856,854, 1020) 1503 Redetermination of Eligibility Request for BMS Investigation 1348 Request for Fair Hearing

 

Food Stamp Only Cases (Notices and Forms Should Be Filed Accordingly)
Section One 1052 Record of Case Action Generic Application/CAD Addendum Food Stamp Expense Addendum 26 Expedite Checklist Generic Recertification Form Penalty Warnings Form 495 Authorization for Investigation Form	Section Two 1747 Food Stamp Claim Report Form 387 Change Form Income Verification Asset Verification Disposition Notices Non-financial Verifications EBT Referral FSET-1 Referral Form FSET-3 Noncompliance Form Photo Id Referral Form Request for BMS Investigation 1348 Request for Fair Hearings 1503 Redetermination of Eligibility