Common Place Handbook Integrated Document … Integrated Document Management (IDM) ... CalWORKs and Welfare to Work Determination ... Employment Questionnaire

Common Place Handbook page 19-1Integrated Document Management (IDM)

19. Integrated Document Management (IDM)

19.1 Introduction

The Integrated Document Management (IDM) system was implemented to improve access of work-related documents to SSA employees by providing faster, easier, and secure retrieval of documents and case information by multiple concurrent users. The IDM system allows SSA to preserve and backup existing documents while reducing paper storage space requirements.

19.2 Policy

The implementation of CalWIN and the New Business Models advanced the agency’s goal to transition to a paperless case environment.

19.2.1 New Benefit Intake Cases

All new CalWIN Benefit Intake cases are electronic cases ONLY and MUST be maintained as electronic cases. This means that a paper case file is NEVER to be created for these cases and therefore ALL forms, correspondence, verifications, etc. received MUST be scanned into the IDM system.

19.2.2 New CWES Intake Cases

All new CalWIN CWES Intake cases are electronic cases only and MUST be maintained as electronic cases. This means that a paper case file is NEVER to be created for these cases and therefore ALL forms, correspondence, verifications, etc. received MUST be scanned into the IDM system.

Update # 16-10 Revised: 5/13/16

page 19-2 Common Place HandbookIntegrated Document Management (IDM)

19.2.3 Full Scan for Intake Cases

Prior to requesting a case for an intake office from the Retention Center, clerical staff at the intake office must review Case Track/Retrieval to see if the case has been scanned. If it has been scanned, the paper case file is not required and is NOT to be requested.

When a paper case file is requested from the Retention Center for an Intake office, a full scan of the case must be performed by the Retention Center staff. The Intake office is sent an alert when the scan is completed. The case is then considered an E-CASE and MUST be maintained as an e-case which means ALL further correspondence, forms, and verifications received MUST be scanned into the IDM system.

19.2.4 Add-a-Program IDM Procedures

The following procedures are to be used for scanning cases for Add-a-Program applications:

If the Application is a(n)... Then...

Immediate Need / Expedited Services (Paper Case),

• Intake will send a fax to the continuing office’s attention (Case Loan) as a courtesy notification of IN/ES.

• Continuing clerical will get fax and case request on case tracking

• Continuing will scan case for Intake prior to appointment date.

Immediate Need/ Expedited Services (E-Case),

• Intake will send a fax to the continuing office’s attention (Case Loan) as a courtesy notification of IN/ES.

• Intake will write “Scanned” on the fax and the case number on the document.

Regular Add-a-Program (Paper Case),

• Continuing will get case request through case tracking.

• Continuing will scan case for Intake within 10 days

Regular Add-a-Program (E-Case),

• Intake will change worker number in CalWIN and email worker or control clerk, as applicable.

Revised: 5/13/16 Update # 16-10


19.2.5 Retention Center - Other Requests for Paper Case Files

When a paper case file is requested by Appeals, IEVS/CROP or Quality Control, the Retention Center is to send the paper case file within 24 hours of the request. Scanning of the paper case request is NOT to be performed. (If the paper case request has been scanned and it is over 30 days of scan date, there will be NO paper case to send and the requestor must view the case in IDM retrieval).

19.2.6 Partially Scanned Cases

Once a case has been scanned into the IDM system, it is considered an electronic case file in IDM and MUST be maintained in IDM. After the partial scan is completed, ALL further correspondence, forms, verification received MUST be scanned into the IDM system.

19.2.7 Benefits Cases

As of June 1, 2006, any further documents, forms or verifications received for a Benefit case MUST be scanned into the IDM system. This includes the following:

1. All application forms. The ENTIRE Statement of Facts (SOF) form must be scanned into the IDM system.

2. All annual redetermination/recertifications forms. The ENTIRE Statement of Facts (SOF) must be scanned into the IDM system.

3. Rights and Responsibilities forms signed by the client.

• ONLY the signature page needs to be scanned.

• For Medi-Cal, clients are not required to return or sign the MC 219. If the client returned the signed form, scan the signature page only.

4. Informing Notices that require the signature of the client.

5. The completed and signed "Request for Limited Services" ( MC 4026) form.

6. All income/status reports along with attached verifications.

7. Any correspondence and verifications received from the client.



8. All third party verifications whether on own stationery or county provided forms such as proof of school enrollment.

9. All CalWIN generated forms completed and signed by the client.

10. All shelf-stock forms completed and signed by the client.

11. All non-CalWIN generated client correspondence such as hand-written NOAs.

12. All fraud, overpayment/overissuance, hearing decisions and SFIS paperwork not already in CalWIN.

13. All MEDS screens and IEVS abstracts.

14. Communications between district offices, departments, and other agencies, e.g. non-cooperation notice from the DA’s office.

15. Returned mail – scan only the side of the envelope that shows the date and reason for return. Document on the Maintain Case Comments window what is being returned.

19.2.8 CWES Cases

All CWES documents (including shelf stock issued NOA’s) as identified for an active ES case for both physical and electronic cases. [Refer to “Category/Sub-Category - CWES Chart,” page 19-17 for a listing of CWES documents which need to be imaged.]

19.2.9 SSI Advocacy

Documents that are specifically used by Social Workers for CWES and GA SSI advocacy clients are filed within the appropriate SSI IDM subcategories. [Refer to “Category/Sub-Category - SSI Advocacy Chart,” page 19-27 for a listing of SSI Advocacy documents which need to be imaged].



19.3 Filing Structure in IDM

Filing Protocol Procedures

Maintaining the accuracy of the imaged documents in a case is extremely critical, and the filing structure must be used. Use the Category/Sub-Category filing protocol, which indicates where documents in case files are to imaged. District Office and Retention Center staff will review documents to ensure they are indexed correctly into the category and subcategory identified in this filling protocol:



• PERMANENT VERIFICATION

• REPORTS/INCOME -BENEFITS-CWES

• BENEFITS-F1 - APPLICATION-F2 - CASE VERIF / CHILD SUPPORT-F3 - 278F-F4 - LMO / SCD163 / FIN / CW / GA-F5 - FOOD STAMPS / MEDI-CAL-F6 - MISC- COURT REVIEW / OP / O-MEDS-VSS - JOB SEARCH-VSS - TRAINING ATTENDANCE-VSS - WORK PROJECT

• CWES-F1 - SCREEN SHOTS-F2 - APPLICATION-F3 - CONTACT ACTION SUMMARY-F4 - CHILD CARE-F5 - SUPPORTIVE SERVICES-F6 - WTW AGREEMENTS-F7 - GOOD CAUSE-F8 - NON-COMPLIANCE -F9 - EMPLOYMENT VERIF-F10 - OTHER CORRESPONDENCE-CL/T - CORR / DISCONTIN / NONCOMP-CL/T - REGISTRATION / ORIENTATION-CL/T - SCHOOL VERIF / ATTENDANCE-CL/T - SUPPORTIVE SERVICES

• SSI-CASE VERIFICATIONS-CORRESPONDENCE-APPLICATIONS/APPEALS-MEDICAL

• Permanent Verification, Benefits, Report/Income, SSI and CWES are the Categories.

• Sub-Categories are listed below each Category and examples are F1 - Application, F2 - Case Verif/Child Support, VSS - Job Search, F1 - Screen Shots, F2- Application, Application/Appeals, etc.

• The letter “F” used for Sub-Category indicates Fastener: F1 = Fastener 1, F2 Fastener 2, etc.



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19.4 Category/Subcategory - Benefits

The following chart is to be used to determine the correct Category/ Subcategory to use to scan the documents.

ATEGORYSUB-CATEGORY

DOCUMENTS TO BE SCANNED UNDER THIS CATEGORY/SUB-CATEGORY

ERMANENT ERIFICATION

PERMANENT VERIFICATION

• Photo ID, Driver’s license, SSN, USCIS documents (front and back), SFIS – birth, death, marriage certificates• CA 82 - Agreement to Sell Property• CW 42 - Statement of Facts - Homeless Assistance• CW 2102 - The Maximum Family Grant Rule for Recipients

of Cash Aid• CW 2168 - CalWORKs and Welfare to Work Determination• CW 2184 - CalWORKs 60-Month Time Limit• CW 2186A - CalWORKs and Welfare to Work Time Limit

Exemption Request• CW 2188 - CalWORKs and Welfare to Work Time Limit

Exemption Request• DHCS 0005 - Receipt of Citizenship or Identity documents• DHCS 0011 - Proof of Acceptable CITI ID Documents• MC 13 - Statement of Citizenship, Alienage and Immigration

Status• MC 194 - SSA Referral Notice• MC 215 - Request for Withdrawal and/or Waiver of Ten-Day

Advance Notice• MC 221 - Disability Determination and Transmittal• SCD 46 - One Time Exemption • SCD 58 - Application for Verification of Birth, Death,

Marriage or DIvorce to Determine Eligibility for Public Assistance Programs

• SCD 37 - Multidisciplinary Interview Referral Form• SCD 78 - Time on Aid Record Change• SCD 97 - Statewide Fingerprint Imaging System Referral• SCD 146 - TOA Review Referral• SCD 355 - Agreement to Reimburse• SCD 588 - GA Repayment Responsibility• SCD 840 - Important Notice for Native Americans• SCD 1248 - Application for MFG Rule• SCD 1264 - Language Survey Interpreter/Translator

Request• SCD 1383/CSF 18 - Caretaker Relative Documentation

Chart• (CONTINUED ON NEXT PAGE)



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ERMANENT ERIFICATION

PERMANENT VERIFICATION (CONTINUED)

• SCD 1725 - County Specific Exemption/Extender Review Form

• SCD 1824 - 60-Month Time on Aid Review• SCD 1825 - Tracking Child Support/Overpayment

Recoupment Worksheet• SCD 1826 - Child Support/Overpayment Exemption Review

Summary• SCD 1827 - County Alert to Complete Child

Support/Overpayment Exemption Review• SCD 2251 - Removal of Confidential/Privileged Information• SCD EBT 3/CSF 65 - Electronic Benefit Transfer (EBT)

Exemption from Cash Stagger• SCD EBT 4/CSF 66 - Electronic Benefit Transfer (EBT)

Exemption from Cash• SOC 455 - Cash Assistance Program for Immigrants State

Interim Assistance Reimbursement Authorization• SSP 14 - Authorization for Reimbursement of Interim

Assistance Initial Payment or Initial Posteligibility Payment• Child Support - Court orders• Conservatorship Papers• Divorce Papers• All Immigration forms (i.e., FORM I-90, I-797, I-3288,

I-5650)• Notification of Fraud Conviction• Prucol Forms (G -845, M 845)• SAVE - Response Form

EPORTS / NCOME

BENEFITS • All Status Reports and any documentation that is received with these reports. • AR 2 - Reporting Changes for CalWORKs and CalFresh• AR 3 - Mid-Year Status Report for CalWORKs and CalFresh• MC 176S - Medi-Cal Midyear Status Report• MC 176TMC - Transitional Medi-Cal (TMC) Status Report

(Quarterly)• QR 3 - Mid Quarter Status Report• QR 7 - Quarterly Eligibility/Status Report• QR 72 - Sponsor’s Quarterly Income and Resources Report• QR 73 - Senior Parent Quarterly Income Report• QR 377.5 - Food Stamp Mid-Quarter Status Report• SCD 380/CSF 32 - Income Profit and Loss Statement• SCD 1564/CSF 34 - Daily Tip Statement

ATEGORYSUB-CATEGORY




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ENEFITS • F1 - APPLICATION

For Active Benefits Cases:

• CSF 6 - Appointment Letter for Public Assistance• CSF 22 - Employment Questionnaire• CW 8 - Statement of Facts for an Additional Person• CW8A - Statement of Facts to Add a Child Under Age 16• CW 10 - Notice of Withdrawn Application• CW 23 - Supplemental Statement of Facts - Senior Parent• CW 25 - Supplemental Statement of Facts - Minor Parents• CW 1308 - CalWORKs U-Parent Beginning Date of Aid

Worksheet• CW 2208 - Your WTW 24-Month Time Clock• DFA 285-A1 - Application for Food Stamps - Part I• DFA 285-A2 - Application for Food Stamps - Part II• DFA 285-A3 - Important Facts for Food Stamp Applicants• DHCS 7077 - Notice Regarding Transfer of a Home for both a

Married and an Unmarried Applicant/Beneficiary• DHCS 7077A - Notice Regarding Standards for Medi-Cal

Eligibility• DHS 7068 - Public Guardian/Conservator or Beneficiary

Representative Checklist• DHS 7096 - Department of Developmental Services Waiver

Referral• FC 2 - Statement of Facts Supporting Eligibility for AFDC -

Foster Care• FC 4 - Program Choice Indication• FS 26 - Food Stamp Program Qualifying Drug Felon

Addendum• FS 27 - Non-Assistance Food Stamp (NSFS) Household

Recertification Form• GA 1 - Application for General Assistance• GA 4 - Screening Sheet - Persons over 65• GA 5 - GA Director’s Exception Request• GA 14 - Important Information for Applicants and Recipients of

General Assistance• GA 100 - Statement of Facts for General Assistance• MC 175-1- Income Screening Questions (Sneede)• MC 175-2 - Responsible Relative Determination (Sneede)• MC 179 - 90 Day Status Letter• MC 210 - Medi-Cal New Mail-In Application and Instructions• MC 210A - Supplement to Statement of Facts for Medi-Cal -

Retroactive• MC 210B - Supplement to Statement of Facts (Pickle)• MC 210PS - Property Supplement• MC 210RV - Medi-Cal Annual Redetermination Form• MC 210 S-I - Income In-Kind/Housing Verification• MC 212 - Medi-Cal Residency Declaration

(CONTINUED ON NEXT PAGE)

ATEGORYSUB-CATEGORY




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ENEFITS • F1 - APPLICATION (Continued)

• MC 219 - Important Information for Persons Requesting Medi-Cal

• MC 223 - Applicant’s Supplemental Statement of Facts for Medi-Cal

• MC 250 - Application and Statement of Facts for Child not Living with a Parent or Relative and whom a Public Agency is Assuming Some Financial Responsibility

• MC 262 - Redetermination for Medi-Cal - LTC• MC 306 - Appointment of Representative• MC 321 HFP - Mail In Application for Medi-Cal/Healthy

Families• MC 321 HFP -AP - Additional Persons requesting Medi-Cal• MC 322 - Real & Personal Property• MC 334 - Medi-Cal/Healthy Family Mail in Application

transmittal• MC 341 - Department of Developmental Services Waiver

Approval for Benefits• MC 360 - Notification of Medi-Cal Inter-County Transfer (ICT)• MC 4026 - Request for Eligibility Limited Services• QR 22 - Sponsored Noncitizens Applying for or Receiving

Cash Aid and/or Food Stamps• RS 36 - Employment & Training Requirements for Refugee

Cash Assistance• SAWS 1 - Application for Cash Aid, Food Stamps, and/or

Medi-Cal Assistance• SAWS 2 - Statement of Facts Cash Aid and Food Stamps• SAWS 2A QR - Important Information - Rights and

Responsibilities• SCD 22 - Child Abuse Neglect Referral - Initial Evaluation• SCD 31 - Health Care Options Referral• SCD 41 - Identification and Intake Record (this form is optional

as determined by each office)• SCD 90 - Good News for California Families• SCD 93 A/B/C/D - Medi-Cal Application Coverletter• SCD 103 - Acknowledgement of Limited Sharing of

Information for the Administration of the CalWORKs Program• SCD 115 - Release of Information (CHI)• SCD 166 - Informal Application Refusal/Withdrawal of

Application• SCD 173 - Time on Aid Screening Form• SCD 508 - Would You Like to Register to Vote?• SCD 823 - Medi-Cal Application (Second Notice) • SCD 1121 - Eligibility Verification Checklist• SCD1308 - CalWORKs U-Parent Beginning Date of Aid• SCD1363 - Pickle Screen & Title II DIsregard Computation

Worksheet (CONTINUED ON NEXT PAGE)

ATEGORYSUB-CATEGORY




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ENEFITS • F1 - APPLICATION (Continued)

• SCDEBT 2/CSF 64 - Electronic Benefit Transfer (EBT) Request for Additional Cardholder

• SCD EBT 5/CSF 67 - Electronic Benefit Transfer (EBT) Card and PIN Responsibility Statement

• MC 239 SN-3- Excluded Child Statement• SCD 1707/MC 210 SW- Employment Questionnaire• SCD 2362 - Certification of Confidentiality Non SSA Interpreter

& Release of Information• SOC 453 - CAPI Statement of Household Expenses and

Contributions• SOC 804 - Statement of Facts Determining Continuing

Eligibility for the Cash Assistance Program for Immigrants (CAPI)

• SOC 809 - CAPI Indigence Exception Statement• SOC 813 - CAPI Indigence Exception Determination• SOC 814 - Statement of Facts - CAPI

ATEGORYSUB-CATEGORY




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ENEFITS • F2 - CASE VERIF / CHILD SUPPORT

• CS 909 - Declaration of Paternity• CSF 46 - Immunization Status Record• CSF 49 - Request for Verification of Immunization• CW 2.1 - Child/Spousal and Medical Notice and Agreement• CW 2.1Q - Support Questionnaire• CW 51 - Child Support - Good Cause Claim for

Noncooperation• CW 61 - Authorization to Release Medical Information• CW 371 - Referral to DA for Action on CalWORKs Parent• SCD 95 - Supplemental Child Support Information Paternity

Affidavit• SCD 105 - Family Support Update• SCD 111A - Referral for Possible Misuse of AFDC

Funds/Stepfather Referral• SCD 473 - CalWORKs Sanction Penalty Action• SCD 1257 - Request for Interpreter Services• SCD 1302/CSF 37 - School Attendance Verification and

Release of Information• SCD 1400 - General Assistance Program Request for Medical

Information• SCD 1404 - Food Stamp Work Registration• SCD 1441 - CWES/EW Communication• SCD 1468 - VOLAG/Sponsor• SCD 1603 - Social Service Agency/Family Support Division

Communication• SCD 1604 - Communication between IEVS worker and EW• Absent Parent - Memos to Social Services• All Refugee forms• Court Letter - District Attorney Letter to report to court• Paternity - Memos addressed to DA• The most recent:

• CW 5 - Veteran’s Benefits Verification and Referral• SCD 101/CSF 2 - General Affidavit

(CONTINUED ON NEXT PAGE)

ATEGORYSUB-CATEGORY




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ENEFITS • F2 - CASE VERIF / CHILD SUPPORT (CONTINUED)

• SCD 169 - Referral To/From Social Security• SCD 345 - Non-Needy Relative Statement• SCD 549 - Request for Information from Employer• SCD 955 - AFDC/RCA/ECA Case Review for

Unemployability• SCD 1250 - Preliminary Self-Employment Questionnaire• SCD 1302/CSF 37 - School Attendance Verification and

Release of Information• SCD 1556/CSF 50 - Student Income Verification Request• SCD 1686 - CalWORKs Community Health Alliance

Services Referral• SCD 1782 - Doctor Verification• SCD 1845 - County Health Evaluation Referral Letter• SCD 1947 - Direct Deposit/EBT Communication Special

Notice to Warrant Control• SCD 1948 - Direct Deposit Enrollment Form• Appeals - All documents, for the current year• Pregnancy verifications• Receipts - Latest mortgage papers, rent receipts, utility

receipts• All the following documents which are less than one year old:

• CSF 47 - Housing Statement• CW 71 - Statement Cash Aid Mother and Unrelated Adult

Male• ECS 155 - Earnings Clearance• GA 2 - Shelter Cost Statement• SCD 15/CSF 27 - Insurance Verification• SCD 61/CSF 25 - Special Diet Request• SCD 101 - General Affidavit• SCD 292 - DMV & Legal Information Request• SCD 441 - School Verification (If Child is Over 16)• SCD 832 - Immunization Assessment Form• SCD 1029/CSF 13 - Authorization to Release Information• SCD 1280/CSF 17 - Release of Information - Financial

Institution• SCD 1294 - Eligibility/Public Guardian Communication Form• SCD 1503 - Immunization Verification Form• SCD 1955 - Social Security Information Request or Referral• Claimant Abstract - Embossed Card Claimant Abstract

(Returned when DE 8028 submitted)• DMV - Vehicle registrations, miscellaneous financial

documents, etc.• Immunization - Copy of Yellow Card• Memo - Relinquishment• PVS/IEVS - Printouts• School - Financial Aid Award Letters and Budgets• Social Security - Award Letters• Verifications - Income and Property, UIB/DIB/SD• Hotel Vouchers

ATEGORYSUB-CATEGORY




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ENEFITS • F3 - 278F • RESERVED FOR PARTIAL CASE SCAN

ENEFITS • F4 - LMO / SCD163 / FIN / CW / GA

• LMO & SCD163s - RESERVED FOR PARTIAL CASE SCAN• CalWORKs and GA hand budgets for Non-System

Determined Issuance (NSDI) since 06/05.• CW 2213 - Response to Request to Inspect Case Record• SCD 143 - Consent to Release Social Services Records to an

Authorized Representative for a State Hearing• SCD 145 - Consent to Release Social Services Records to an

Authorized Representative• SCD 270 - NSDI Entry Request• SCD 274 - Fax Request for Benefit Issuance Action• SCD 382 - Declaration of Lost or Destroyed Warrant• SCD 723 - Authorization for Disposition of Returned Warrant• SCD 1156 - Referral to Benefit Issuance for Replacement of

Cashed County Warrant• SCD 1456 - Warrant Replacement - Five-Day Waiver

ATEGORYSUB-CATEGORY




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ENEFITS • F5 - CALFRESH / MEDI-CAL

CalFresh/CalWORKs Forms:

• DFA 285B - CalFresh Budget Worksheet• DFA 285C - Food Stamp Budget Supplemental Application for

Special Medical Deductions• DFA 386 - Notice of Missed Interview• QR 285B -CalFresh Budget Worksheet• SCD 1483 - Social Services Mail Request Agreement• SCD 1615 - Food Stamp Student Income Worksheet• SCD EBT 1 - EBT On-Line Request• SCD EBT 6 - EBT Miscellaneous On-Line Request• NOAs - ALL hand written Food Stamp Notices of Action

Medi-Cal Forms:

• CWC 6041 - Potential Third Party Liability Notification• DHS 6155 - Health Insurance Questionnaire• MC 175 3I.2A - Section 1931(b) Sneede v. Kizer Nonexempt

MBSAC Test Determination and Mini Budget Unit Determination

• MC 17S 3I.2R - Section 1931(b) Sneede v. Kizer net Nonexempt Income Determination And Mini Budget Unit Determination Application

• MC 176 - Series• MC 239 - Medi-Cal Notice of Action Series• MC 355 - Request for Information• SCD 1225 - Notice of Medi-Cal Action• SCD 1233 - Request for Immediate Need Paper BIC• SCD 1596 - SOC Adjustment Worksheet• SCD 1931 A - Section 1931 (b) Review Sheet• SCD 1931 B - Income Determination Budget Worksheet• SCD 1931 C - Recipient Continuation Budget Worksheet• SCD 1931 P - Property Reserve Worksheet Section• SCD 1931 V - Vehicle Determination Worksheet for Section

1931 (b)• SCD 1931 Sneede A - Application Sneede v. Kizer Budget

Worksheet & MBU Determination• SCD 1931 Sneede R - Section 1931 (b) Recipient Sneede v.

Kizer Budget Worksheet & MBU Determination• SCD 2384 - Health and Hospital System Service Referral• DDSD Referral Packet (MC 220, MC 221)• Medical Expense receipts for CalFresh since last RC

ATEGORYSUB-CATEGORY




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ENEFITS F6 - MISCD/ COURT REVIEW / OP / OI

• CW 215/MC 360 - Notification of Inter-County Transfer• GA 16 - SSI Advocacy Response form• GA 17 - SSI Advocacy Case Data• MC 224 A - Medi-Cal Potential Overpayment Reporting Work

Sheet - Income• MC 224 B - Medi-Cal Potential Overpayment Reporting Work

Sheet - Property• MC 609 - Confidential Medi-Cal Complaint Report• SCD 16 - Community Inquiry or Report• SCD 50/SCD 50A - Appointment Notice and Continuation

Page• SCD 130 - Redetermination of Eligibility Notice• SCD 1044 - ICT Redetermination Notice• SCD 155 - Voluntary Placement Agreement• All communications from the DA & Collections • Correspondence - Clients notes, SCD50s, returned mail

envelope, any Court Order including Petitions• Court Review materials, notices, budgets, overpayment

correspondence, etc.• Reimbursement Agreement computation and documents• The following forms from Appeals Unit

• SCD 555 - Notice of Filing of Fair Hearing• Fair Hearing Decision• SCD 1562 - Report of Compliance with Adopted Fair

Hearing Decision• The following forms completed by CROP/IEVS:

• DFA 285B - CalFresh Budget Worksheet• DFA 285C - Food Stamp Budget Supplemental Application• DFA 842 - Claim Determination Worksheet• DFA 377.7C - Food Stamp Repayment Agreement for

Inadvertent Household Errors Only• QR 285B - CalFresh Budget Worksheet• SCD 11 - Overpayment Worksheet• SCD 54 - Fraud Referral to Special Investigative Unit• SCD 54A - Income and Eligibility Verification System Fraud

Referral to Special Investigative Unit• SCD 141 - Notification to Collections When Case Closes• SCD 157 - AFDC Overpayment Computation Worksheet• SCD 233 - AFDC IPV Notification - fOOD • SCD 271 - CalWORKs Intentional Program Violation

Tracking• SCD 683 - Fraud Closing Memo• SCD 1212 - AFDC Overpayment Adjustment Computation

Worksheet• SCD 1253 - Overpayment Referral• SCD 1354 - Food Stamp Intentional Program Violation (IPV)

Disqualification Notifications• Overpayment packets including all NOAs

ATEGORYSUB-CATEGORY




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19.5 Category/Sub-Category - CWES Chart

The following chart is to be used to determine what CWES documents need to be scanned into the IDM system and the correct CWES Category/Subcategory to use to store the documents:

ENEFITS MEDS • SCD 1296 - Request for MEDS Online Action • SCD 1296 - Request for MEDS Online Action (CalFresh)• MEDS/CDB Exception Reports• MEDS/CDB Screen Prints

ENEFITS VSS - JOB SEARCH

• Job Search Form (SC1527)• Related documents pertaining to each Job Search Form

(SC1527)• CalWIN Activity Date Entry Form (GA30)

ENEFITS VSS - TRAINING ATTENDANCE

• Public Work Project Job Assignment and Time Sheet (GA9)• Related documents pertaining to each Work Project

Assignment Time Sheet (GA9)

ENEFITS VSS - WORK PROJECT

• Monthly Attendance Report (GA68)• Related documents including school verifications/class

schedules

CATEGORY SUB-CATEGORYDOCUMENTS TO BE SCANNED UNDER THIS CATEGORY/SUB-CATEGORY

PERMANENT VERIFICATION • ID, Driver’s license, SSN, USCIS, SFIS – birth, death, marriage certificates

REPORTS/ INCOME

CWES All Status Reports and any documentation that is received with these reports.

• SCD 1755 - Attendance & Child Care Billing• Paycheck Stubs• SCD 1756- Distance Learning Student Log

CWES F1 - SCREEN SHOTS For use by Retention Center Only.

• For Closed Cases: All documents under Fastener 1 of the case folder.

ATEGORYSUB-CATEGORY




CWES • F2 - APPLICATION For Active CWES Cases:

• CalWORKS Client Health Alliance OCAT Screener Tool

• OCAT Appraisal Summary Report (ASR)• SCD 54 - Fraud Referral to Investigative Unit • SCD 103 - Acknowledgement of Limited Sharing of

Information for the Administration of the CalWORKs Program

• SCD 1029 SCD 1029/CSF 13 - Authorization to Release Information

• SCD 1771 - Self Appraisal• SCD 1772 - OCAT Client Self-Appraisal

Questionnaire• SCD 1784 - CWES ORIENTATION CLIENT

SCREENER• SCD 1858 - Orientation Letter• SCD 2362 - Certification of Confidentiality Non SSA

Interpreter & Release of Information• WTW 9 - WTW Appraisal Appointment Letter• WTW 10 - Request for 3rd Party Assessment• WTW 17 - Waiver of CalWorks Learning Disabilities• WTW 18 - Learning Needs Screening

Coversheet-Directions for County Worker• WTW 20 - Permission to Release Learning

Disabilities Information• The following forms from Appeals Unit

• SCD 555 - Notice of Filing of Fair Hearing• Fair Hearing Decision• SCD 1562 - Report of Compliance with Adopted

Fair Hearing Decision

CWES • F3 - CONTACT-ACTION SUMMARY

For Active CWES Cases:

• For entries dated 7/98 and ongoing.• All SCD 163 documents i.e. Stage II, Close, etc.




CWES • F4 - CHILD CARE For Active CWES Cases:

• CCP7 CalWORKs STAGE ONE CHILD CARE REQUEST FORM & PAYMENT RULES

• Child Care NOA’s• NA832-Child Care Approval• NA833-Child Care Change• NA834-Child Care Denial• NA835-Child Care Discontinuance

• Community Child Care Council of Santa Clara County Inc. (4C Council)—(Parent Confirmation Notice)

• CD 7617 - Notice of Action (CA Dept. of Education - Child Development Division)

• CD 9600 - Confidential App. for Child Development Services & Certification of Elig.

• Admission Agreement Contract (SJC/Evergreen) Child Development Centers

• Personal Rights - Child Care Facilities• Provider Driver License• Provider License• Provider SSN• SCD 511 - Trustline Referral-Parent Eligibility

Certification• SCD 533 - Checklist for Trustline and Health and

Safety Self- Certif and Health and Safety Self-Certification

• SCD 957 - CalWORKs Stage II Screener (No Folder)• SCD1178 - Health and Safety Facility Checklist• SCD 1179 - Health and Safety Self-Certification• SCD 1415 - Child Care Receipt• SCD 1713 - Alternative Payment

Program/CalWORKs Employment Services Referral Update

• SCD 1717 - Alternative Payment Program Direct Referral

• SCD 1723A - CalLearn Communication Form• SCD 1736 - Child Care Payment Adjustment Notice • SCD 1752 - Licensed Provider Registration and all

Provider Changes• SCD 1753 - License-Exempt Home

Certification/Registration• SCD 1776 - App/CWES Referral & Communication

Form• SCD 1777A - CalWORKs Child Care Referral Notice

A• SCD 1786 - CalWORKs Referral to 4Cs• W-9 - Request for Tax Player Identification Number &

Certification




CWES • F5 - SUPPORTIVE SERVICES


• Ancillary Request: varies• Auto Insurance• Mileage Verification Documents• Receipts• Outreach Materials• SCD 2379 - Dress for Success Client Referral• Payment Vouchers

• SCD 1304 - Textbook Voucher• SCD 1584 - Ancillary Expenses Estimate, Request

and Verification• SCD 1787 - Jump Start Auto Repair Request for

Vehicle Repair• SCD 1787A - Jump Start Auto Repair Diagnostic

Referral and Results• SCD 1799A - Reimbursement Request for

Transportation-Related Expenses• SCD 2232 - OUTREACH Bike to Work Services

Referral• Family Services:

• FSP 2 - Family Stabilization Program Denial NOA• FSP 3 - Family Stabilization Program Change in

Program Status NOA• SCD 2416 - Family Stabilization Housing

Assistance Referral• SCD 2417 - Family Services Request & Application• SCD 2419 - CalWORKs Housing Support Program

Referral• Transportation NOA:

• NA820-Transportation Approval• NA821-Transportation Denial• NA822-Transportation Change• NA824 Transportation Extension• NA 825-WTW Transportation Approved Lesser

Amount• Warrant Replacement Forms

• SCD 382/CSF 1 - Declaration of Lost or Destroyed Warrant

• SCD 723 - Authorization for Disposition of Returned Warrants

• SCD 1156 - Replacement of Cashed County Warrant

• SCD 1456 - Warrant Replacement Five Day Waiver• Work and Training Related NOA:

• NA823 - Ancillary Approval & Denial




CWES • F6 - WTW AGREEMENTS

For Active CWES Cases

• CalWORKs Work Study Schedule A• Class/Work Form• CSF7 - Assessment Appointment• LD related Plan• Labor Market Needs Verification• Monthly Participant Report• Post Aid Services 60-Day Agreement• SCD 29 - CalWORKs Referral• SCD 380/CSF32 - Income Profit & Loss Statement• SCD 1302/CSF 37 - School Attendance Verification

and Release of Information• SCD 1555 - CalWORKs Domestic Abuse (DA)

Service Plan• SCD 1686 - CalWORKs Community Health Alliance

Services Referral• SCD 1723 - WTW Activity Referral Form• SCD 1756 - College Liaison Appointment Notice/Sip

Verification• SCD 1757 - Education & Training Services Referral• SCD 1757A - Education & Training Result & Update• SCD 1758 - Educational Plan• SCD 1760 - Employment Plan• SCD 1764 - Referral to Employment Services• SCD 1764B - Referral to Job Search Services• SCD 1765 - Job Club Workshop/Job Search

Networking Verification• SCD 1766 - Participation Problem & Attendance Alert• SCD 1767 - Termination and Completion Request• SCD 1768A - Progress Report & Recommendations• SCD 1773 - Employment Plan Report• SCD 1778 - Self-Initiated Program Denial/Extension

Denial• SCD 1789 - SCC Works Worksite Referral• SCD 1811 - CalWORKs/DFCS Common Case• SCD 1812 - CalWORKs/DFCS Intake Referral • SCD 1860 - SCD 2275 - Referral to TSE Transitional

Sub Empl• SCD 2229 - Important Notice to CalWORKs Recipient• Family Services:

• SCD 2392 - Family Service Plan• SCD 2418-A - Family Services Weekly

Employment Plan• SCD 2418-B - Family Services Weekly Housing

Search Plan




CWES • F6 - WTW AGREEMENTS (CONTINUED)

• TBA Form Lab Classes• TOA Extender Request• Verification of (school) enrollment• WIN (Workforce Initiative Network)• WTW 1- CalWORKs Employment Services Rights &

Responsibilities (Modified)• WTW 2/3 - CalWIN Plan/Activity Assignment • WTW 8 - Student Financial Aid Statement• WTW 15 - Simplified Food Stamp Program Unpaid

WEX & Unpaid Community)• WTW 29 - Plan to Stop a WTW Sanction• WTW 38 - Welfare-to-Work 24-Month Time Clock

Notice• WTW 43 - Notice of Your Welfare-to-Work (WTW)

24-Month Time Clock Ending Soon• WTW 44 - End of Welfare-to-Work 24-Month Time

Clock Review Appointment Letter• WTW 45 - WTW 24-Month Time Clock Extension

Determination• WTW 46 - End of Welfare-to-Work 24-Month Time

Clock Review Appointment Letter• WTW 47 - Online CalWORKs Appraisal Tool Rights &

Privacy• NA 1276 - End of WTW 24-Month Time Clock

CWES • F7 - GOOD CAUSE/ EXEMPTIONS


• Medical related reports: • CW 61 - Authorization to Release Medical

Information• CW 61A - Physical Capacities• CW 61B - Mental Capacities

• CW 2186 A - CalWORKs and Welfare to Work Time Limit Exemption Request Form

• CW 2186 B - CalWORKs and Welfare to Work Time Limit Exemption Determination

• Medical, Any other related supporting documents• SCD 1715 - CalWORKs Social Work Unit SSI

Referral• SCD 1554 - CalWORKs Domestic Abuse

Participation Status• SCD 1782 - Doctor Verification




CWES • F8 - NON-COMPLIANCE

For Active CWES new Intake cases:

• All RETURNED non-compliance mail• Good Cause Verification• NA 840 - CalWIN Non-Compliance • NA 840A - CalWIN Noncompliance • NA 841 - CW/WTW/NOA • NA 845 - Notice of Participation Problem, Cause

Determination & Compliance Appt.• SCD 473 - CalWORKs Sanction/Penalty Action• SCD 501 - Agreement to Lift CalWORKs Sanction• SCD 1779 - Notice PF Missed Participation• SCD 1780 - Notice of Missed Participation

Appointment• WTW 4 - Notice to Other Parent • WTW 27 - Reason for Good Cause Notice• WTW 32 - Compliance Plan

CWES • F9 - EMPLOYMENT VERIFICATION


• CSF 22 - Employment Verification • Placement Information (from Employment

Connection) • SCD549 - Employment Verification• SCD1818 - Employment Verification• SCD1838 - Employment Verification Release Form• SCD 2169A - Employment Participation

Requirements Agreement




CWES • F10 - OTHER CORRESPONDENCE

• All RETURN Mail except for Non-compliance documents (Non-Compliance Returned Mail is scanned under F8 Sub-category)

• CSF 6 - Appointment Letter• gis 102s - Speedletter Request for Verification• Housing Authority Authorization for Release of

Information• Miscellaneous• PAS Correspondence • SCD 24 - Child Care Follow Up• SCD 50 - Appointment Notice• SCD 101 - General Affidavit/CSF 2 - General Affidavit• SCD 101 A - General Affidavit - Continuation• SCD 325 - Employed Letter• SCD 1257 - Request for Interpreter• SCD 1725 - County Specific Exemption/Extender

Review Form• SCD 1783 - Drop-In/Return Appointment or Return

Documents• SCD 1788 - Child Care Provider Overpayment Notice• SCD 1798 - CWES Overpayment/Underpayment

Worksheet & Referral• SCD 1807 - SCC Works Participant Worksite

Agreement• SCD 1851 - Cancellation of Supportive Services

Overpayment• SCD 1853 - Notice of Temporary Postponement in the

Recovery/Collection of Supportive Services Overpayment

• SCD 2272 Individual Intake Request• WTW 11 - Overpayment Notice• WTW 12 - Supportive Services Repayment

Agreement




CWES • CL/T - CORR/DISCONTIN/NONCOMP

For Active Cal Learn and Teen Cases

• CL 3 - Cal-Learn Notice of Participation Problem • CL 9 - Cal-Learn Notice of No Good Cause

Determination • Coversheet for Returned Documents & Reasons• "form" Monthly participation reports if at GED• "form" Vouchers for GED tests• General Communication/Correspondence• NA 840 - CalWin Non-Compliance• NA 840A - CalWin Non-Compliance • NA 843 - CalLearn Discontinuance• NA 845 - Notice of Participation Problem, Cause

Determination & Compliance Appt. • SCD 62 - CalLearn Communication (Penalty)• SCD 473 - CalWorks Sanction/Penalty Action• SCD 1779 - Notice PF Missed Participation• SCD 1780 - Notice of Missed Participation

Appointment• WTW 27 - Reason for Good Cause Notice• WTW 32 - Compliance Plan

CWES • CL/T - REGISTRATION/ ORIENTATION


• CL1 - CalLearn Registration/Program Information/Orientation Appointment Notice

• CL2 - CalLearn Program Requirements• CL8 - CalLearn Notice of Report Card Submittal

Schedule• Teen form: SCD1771 Self Appraisal• Teen form: SCD1772 Appraisal questionnaire• Teen form: SCD1784 CWES ORIENTATION Client

Screener• Teen form: SCD1858 Orientation Letter• Teen form: WTW 1 CalWorks Employment Services

Rights & Responsibilities (Modified)• Teen form: WTW 2/3 CalWorks Plan/Activity

Assignment• Teen form: WTW 8 Student Financial Aid Statement




CWES • CL/T - SCHOOL VERIF/ ATTENDANCE


• Class/Work Form• CL 10 - Cal-Learn Notice of Exemption/Deferral• CSF 7 - Assessment Appointment• CSF 22 - Employment Verification • CW 61 - Authorization to Release Medical Information • CW 61A - Physical Capacities• CW 61B - Mental Capacities• GED Completion Verification• High School Diploma• Medical, Any other related supporting documents • Memo of Good Cause with Supervisor Approval• Monthly Participant Report• NA 844 - (No Change of Grant) • Progress Report• Report Card• SCD 50 - Notice• SCD 62 - Cal-Learn Communication (Adequate or

Satisfactory Progress)• SCD 549 - Employment Verification• SCD 1302 - School Attendance Verification &

Release of Information• SCD 1554 - CalWorks Domestic Abuse Participation

Status• SCD 1686 - CalWorks Community Health Alliance

Services Referral• SCD 1755 - Attendance & Child Care Billing • SCD 1756 - College Liaison Appointment Notice/SIP

Verification• SCD 1758 - Educational Plan• SCD 1759 - Notice of Client Status Change • SCD 1766 - Participation Problem & Attendance Alert• SCD 1767 - Termination and Completion Request• SCD 1773 - Employment Plan Report • SCD 1782 - Doctor Verification • SCD 1783 - Drop-In/Return Appointment or Return

Documents• SCD 1818 - Employment Verification• TBA Form Lab Classes• Verification of (school) enrollment




19.6 Category/Sub-Category - SSI Advocacy Chart

The following chart is to be used to determine what SSI Advocacy documents that are used by CalWORKs and GA Social Workers need to be scanned into the IDM system and the correct SSI Category/Subcategory to use to store the documents:

CWES • CL/T - SUPPORTIVE SERVICES

For Active Cal Learn and Teen Cases:

• Class Syllabus• Confirmation for ancillary items on School Letterhead• NA820 - Transportation Approval• NA821 - Transportation Denial• NA822 - Transportation Change• NA823 - Ancillary Approval/Denial• NA824 - Transportation Extension• Receipts for ancillary items• SCD 72 - CalLearn School Enrollment Verification• SCD 382 - Declaration of Lost or Destroyed Warrant• SCD 723 - Authorization for Disposition of Returned

Warrants• SCD 1156 - Replacement of Cashed County Warrant • SCD 1304 - Textbook Voucher• SCD 1584 - Ancillary Expenses Estimate, Request

and Verification


SSI Case Verifications • GA (initial) “SSI Advocacy Communication• SSA 1696 “Appointment of Representative”

SSI Correspondence • Incoming Mall• All Incoming letters• CE Notice (For appointments NOT expired)• Faxes• GA 16 (Ongoing) “SSI Advocacy Communication

Form”• MEF IP “Request for medical records from

DDS/SSA and bar code• SCD 169 “Referral To/From Social Security”




Note:These subcategories require confidential worker IDM user profile.

SSI Correspondence (Cont.)

• Outgoing Mall• All outgoing letters• Copy of completed Medical Release Forms • Emails• Memorandums• Faxes• Request for Information• Request for medical records from DDS/SSA and

SSI Application/Appeals • Appeals Council• All documents submitted with claim

• Hearing

• All documents submitted with claim• HA 501 “Request for Hearing by Administrative

Law Judge”• SSA 3441"Disablllty Report - Appeal”

• Reconsideration

• All documents submitted with claim• SSA 3373 (ADL 's) “Function Report - Adult”• SSA 561 “Request for Reconsideration”• SSA 3441 “Disability Report - Appeal”

• Initial Claim

• All documents submitted with claim• SSA 3373 (ADL 's) “Function Report - Adult”• SSA 3368 “Disability Report - Adult''• SSA 8011 ''Statement of Household Expense and

Contributions”

Medical Medical • Doctor’s Notes• Medical Records• Psychological Records• SCD 1400 “General Assistance Program Request for

Medical Information• Special Education School Reports




19.7 Category/Sub-Category - Foster Care Chart

The following chart is to be used to determine what Foster Care documents that are used by workers need to be scanned into the IDM system and the correct Category/Subcategory to use to store the documents.




FOSTER CARE

• F-1 APPLICATIONS • AAP Case Information• AB 362/882* - SED Out of Home Placement Payment

Authorization• ACE 1 - MEDS screen with approval dates• ARC 1 - Statement of Facts Supporting Eligibility for

Approved Relative Caregiver program• CA 1 - Application for cash aid, CalFresh• CW 215 - Notification of Inter-County Transfer• DFCS Children’s Shelter Intake Form• EA 1 - Emergency Assistance Application for Child

Welfare• FC 18 - Inter-County Transfer form and other

documents in transfer packet• FC 2 - Statement of Facts Supporting Eligibility for

AFDC Foster Care• ICAMA Form 7.01 - Notice of Medicaid Eligibility/Case

Activation• ICAMA Form 7.02 - Notice to Families• ICAMA Form 7.02b - Important Information for

Families• ICAMA Form 6.03 - Report of Change in Child/Family

Status• ICAMA Form 7.5 - Information Exchange and

Additional Children• ICAMA Form 7.5b - Information for ICAMA

Administrator• KG 2 - Statement of Facts for Kin-GAP• KG 2A - Kin-GAP Rights and Responsibilities• MC 250 - Application and Statement of Facts• MC 360 - Notification of Medi-Cal Inter-County

Transfer• MC 845 - PRUCOL Application• SAWS 1* - Application for Cash Aid, Food

Stamps,Medi-Cal• SAWS 2 - Voluntary Placement Application• SAWS 2A/JA 2 - Rights, Responsibilities and Other

Important Information• SCD 1110 - Welfare Reform Review• SCD 508 - Voter Registration Form• SCD FC 41 - Identification and Intake Record• SCZ 263B - Slot Request RISC Referral• SCZ 63 - SCC RISC Referral and Mental Health RCL

13/14 Youth Certification• SED Approval Letter*• SOC 369 - Disclosure Form Kin-GAP • STEP TILP - Transitional Independent Living Plan



The asterisk (*) symbol is used to indicate that the form is no longer in use. These forms are included for historical purposes only.

FOSTER CARE

• F-2 PERMANENT VERIFICATIONS

• Birth Certificate• FC 4 - Program Choice Indicator• FC 8 - Federal Eligibility for AAP• Legal Guardianship - Petition of Guardianship / Letter

of Guardianship / Court Orders for Legal Guardianship

• MC 13 - Statement of Citizen Status• MC 194 - SSA Referral Notice• Rosales vs. Thompson• SCD 109 - Birth Verification• SCD 1264 - Language Survey / Interpreter

Translation Request• SCD 1383 - Caretaker / Relative Documentation

Chart• SCD 58 - Application for Verification of Marriage,

Death, Birth or Divorce• SCD 836 - Lump Sum Form• SCZ 200G• Social Security Card• SS 5 - Application for a Social Security Card• Termination of Parental Rights (Freed Child Memo)

FOSTER CARE

• F-3 INITIAL DETERMINATION

• AAP Approval Package• AAP 2• AAP 4• FC RU• FC 10• Summary of Initial AAP Request

• AAP 1 - Request for Adoption Assistance• Detention Hearing Court Order• FC 3 - Determination of Federal Foster Care Eligibility• FC 3A - Supplement of FC 3; Worksheet for AFDC

FG/U, parent letter• IEVS 410 - IEVS Report• Initial Detention Minute Order• JV 100 - Juvenile Dependency Petition• Initial Petition• JV 640 for Dual Status - court document terminating

600 and reinstating 300• QR 7* - Eligibility/Status Quarterly Report • SC 1707 - Medi-Cal/CalWORKs Employment

Questionnaire for UP Deprivation• SCD 1533 - Information Regarding Foster Care

Eligibility• SOC 155 - Voluntary Placement Agreement





FOSTER CARE

• F-4 CASE VERIFICATIONS / CHILD SUPPORT

• CA 5 - Veterans Benefits• CW 51 - Child Support Good Cause Claim for

Noncooperation• CW 2.1 - Child and Spousal Medical Support Notice

and Agreement• CW 2.1Q - Support Questionnaire• CW 371 - Local Child Support Agency• DA Court Orders

• Court Orders that establish paternity and/or payment plan

• Individual Living Plan (ILP) Referral• Immunization Record• KG 1 - Kin-GAP Mutual Agreement for 18 year olds• SCD 95 - Supplemental Child Support Paternity

Affidavit• SCD 105 - Family Support Update• SCD 1257 - Request for Interpreter Services• SCD 1603 - SSA/LCSA Communication• SCD 37 - School Attendance form for Kin-GAP• SCD 38 - Important Information About Financial

Responsibility to Support Your Child• SCD 441 - School Enrollment Verification• SCD 54 - Fraud Referral• SCD 692 - Federal Medicaid Title IV-E

Eligibility/Ineligibility & M/C Financial Plan• Social Security Administration (SSA) Award Letter• SSA/SSI - 1633 Forms Series• SSA 11BK - Request to be Selected as Payee• SCD 169 - Social Security Administration Referral

Notice• SCD 196 - Requirement to Provide SS Cards• SCD 1955 - Social Security Information Request and

Referral





FOSTER CARE

• F-5 PLACEMENT / PAYMENT

• Intensive Treatment Foster Care Services (ITFCS)• SCZ 685 - Services Rate Schedule• SCD 688 - ITFCS Referral

• Rates - Correspondence from Group Homes and FFAs regarding rates for payment

• RFHIAC - Resource Family Home Intitial Approval Certificate

• San Andreas Regional Center (SARC) - Dual Agency Letter

• SARC/DFCS Communication - AB 250 Joint Client form

• SCD 30 - Foster Care Budget Worksheet• SCD 2249 - AAP RRR Summary• SCZ 4 - Dual Agency Rate and/or Supplement

Authorization• SCZ 4a - Verification of Child’s Dual Agency Status

Letter• SCZ 414A / SCZ 414D - DFCS Special Funds

Request• SCZ 1328 - Authorization for Emergency Satellite

Home• SOC 158A - Foster Care Child’s Data Record and

AFCD-FC Certification• SOC 815 - Approval of Family Caregiver Home• SOC 817 - Checklist of Health and Safety Standards

for Approval of Family Caregiver Home• SOC 819 - Relative or Non-Relative Extended Family

Member Caregiver Assessment• SOC 836 - Supplement to the Rate Eligibility Form• SOC 837 - Supplement to the Rate Questionnaire• Speed Letter 980 - Speed Letter Notification of

Recertification• STEP TILP - Transitional Independent Living Program

vouchers and invoices• WrapAround - Vouchers and invoices





FOSTER CARE

• F-6 BENEFIT ISSUANCE / RECOVERY / APPEALS

• ACCESS documents from OCM• Appeals documents• Copy of ‘cancelled’ warrant• Designated Payee document• EDP - Any printed screen: Only the HH, E G. PDt1 &

Z Screens (which pertain to the LMO *Not MEDS Screens) or 278 F

• Foster Care Discontinuation Form• SCD 13 - Foster Care Overpayment Report and/or

any Overpayment paperwork• SCD 274 - Fax Request for Benefit Issuance Action • SCD 1156 - Referral to Warrant Control• SCD 1456 - 5-Day Waiver• SCD 1948 - Direct Deposit Form• SCD 270 - Non System Determined Issuance Entry

Request• SCD 381 - Notification to Fiscal Division• SCD 382 - Declaration of Lost or Destroyed Warrant -

Payment History• SCD 729 - Authorization for Release of Information -

Lost Warrant

FOSTER CARE

• F-7 CORRESPONDENCE/ EMAILS

• Address change forms• Letters from adoptive parents• Letters from foster care providers• RRR Notices• SCD 152 - WHIS Screen - Verification of Benefits• SCD 163/email/memo - Contact Action Summary• SCD 50/MC 355/communication letter/email• Special Need Renewal notice

FOSTER CARE

• F-8 MEDS • DHS 6155 - Health Insurance Questionnaire• MEDS screens• MEDS tickets• SCD 1296 - Request for Online Transaction





FOSTER CARE

• F-9 CONFIDENTIAL / OTHER COURT DOCUMENTS

• AD 907 - Adoptive Placement Agreement• Addendum Reports• ADOPT 215 - Order of Adoption• Court Petition - Petition for Adoption• Dependency Initial Hearing Report• Dismissal of Dependency - Minute Order• Juvenile Probation Department (JPD) Permanency

Planning Hearing• JPD Removal• Jurisdiction Disposition - from Social Worker or

Probation Officer• Minute Orders• Status Review Reports• Subsequent Court Minute Orders• Welfare & Institutions Code Report/Documentation

FOSTER CARE

• F-10 NOAs • Notice of Action forms that were modified and not saved in CalWIN.





19.8 Processing of Periodic Reports

On July 1, 2005, the Department of Employment and Benefits Services (DEBS) began scanning Periodic Reports and their attached verifications.

The following Periodic Reports MUST be scanned into the IDM system:

• Quarterly Eligibility/Status Report (QR 7)• Medi-Cal Midyear Status Report (MC 176 S)• Transitional Medi-Cal Quarterly Status Report (MC 176 TMC)• Mid-Quarter Status Report (QR 3).• Daily Tip Statement (CSF 34)• Self-Employment Sworn Statement (CSF 35/SCD 380)• Food Stamp Household Change Report (DFA 377.5)• Sponsor’s Quarterly Income & Resources Report (QR 72)• Senior Parent’s Quarterly Income Report (QR 73)

Processing Procedures

The QR7, MC 176 S and MC 176 TMC are sent to the clients with a return envelope pre-addressed to the Julian Street office.

The steps in the processing of Periodic Reports received at the Centralized Support Services Mail Center are outlined below:

PROCESSING OF PERIODIC REPORTS AND ATTACHED VERIFICATIONS

STEP WHO ACTION

1. Centralized Support Services Mail Center staff

• Opens the envelopes received in the Centralized Support Services Mail Center.

• Removes the Periodic Report and attaches the verifications to the envelope.

• Date stamps the Periodic Report.• Clips the Periodic Report to the envelope.• Bundles and forwards the Periodic Reports to the

appropriate District Offices (Non-Pilot offices only).

Note: For Periodic Reports that belong to Pilot offices, follows step 2.



Note:Eligibility staff at BSC will follow the “In-house” process for processing periodic reports assigned to them.

2. Centralized Support Service/District Office Clerical Staff

• Receives the bundle of periodic reports.• Prepares the documents for scanning.• Generates the category batch header sheet and the

separator sheets from the IDM BarCode Generator Application.

• Assembles the Batch (report with attached verifications/correspondence/forms).

• Scans, verifies, indexes and submits the batch in IDM.• Performs Quality Assurance (QA) check on the batch.• Clips any documents/verifications received to the hard

copy of the periodic report.• Logs the Periodic Reports into CalWIN as received

using the barcode reader.• Mails originals back to the client.• Stores the Reports by date• Burn bags the documents after 30 days.

3. Eligibility Worker • Receives CalWIN alert of the Periodic Report. • Enters Program Level Report Details in CalWIN.• Records as Complete or Incomplete. Must use Return

Status if incomplete. Refer to the CalWIN Announcement (CA) 235, “Return Incomplete Periodic Report” for detail instructions.

• Updates CalWIN with changes reported on the periodic report (if applicable).

• Runs EDBC and Authorizes future benefits.• Documents in CalWIN Maintain Case Comments

window that the periodic report was processed.• Verifies that the Periodic Report and verifications are in

the IDM system and are readable and complete.• Mails all original verifications back to the client.• Places the original periodic report in a designated box

when finished processing it.

UNDER NO CIRCUMSTANCES ARE THE PERIODIC REPORT(S) TO BE FILED IN THE PAPER CASE FILE!

4. District Office Clerical Staff

• Picks up the periodic reports daily.• Store the Reports by date.• Burn Bags the documents AFTER 30 days.

PROCESSING OF PERIODIC REPORTS AND ATTACHED VERIFICATIONS

STEP WHO ACTION



District Office Processing Procedure

Periodic Reports which are mailed to or dropped off in a District Office lobby mail basket or after hours drop box are to be processed by District Office staff using the procedure outlined in the chart above, modifying Step 1 as necessary.

19.9 IDM Quality Assurance

In performing the steps below, staff must remember to keep the equipment clean. A routine must be established throughout the day to keep the scanning equipment as well as the surrounding work surface free of dust. Recommended steps are posted on the SSA Intranet/Department/IDM. By taking an active responsibility in maintaining the scanning equipment we are all taking an important step towards achieving a high level of quality assurance.

The following chart outlines the basic steps in the IDM process.

STEP ACTION

1. Assembling the Batch

• Ensure that the documents to be scanned are readable

• If Batch by Category

• The Batch Header Sheet must contain the Category information and the Document Separator Sheets must contain the Case information

• When assembling the batch, ensure that the printed Case Document Separator Sheets are matched up with the correct Case documents

• If Batch by Case

• The Batch Header Sheet must contain the Case Information and the Document Separator Sheets must contain the Category information

• Ensure that the Category Document Separator Sheets are correctly inserted into the batch

• Use the ‘SCANNED AS IS’ hand stamp only when the following criteria are met:

• When documents are of poor quality and CANNOT be fixed by the scanning staff (e.g.: old or bad copies that are too dark or too light and cannot be corrected; torn or destroyed pages affecting the written information; crooked or cut off pages affecting written information).

• When the incoming document CANNOT be returned to the worker to secure a legible copy.

• Place the stamp on the page, ensuring no information is covered by the stamp.


http://intranet.ssa.co.santa-clara.ca.us/department/idm/


2. Scanning

• Ensure that the batch is assembled correctly prior to placing the batch in the scanner

• Always watch the scanner and look for documents that do not feed correctly

• When a document feeds incorrectly, flag the document so that it can be fixed during the Image Verification step

3. Image Verification

• Verify that the scanned images match the hard copy batch when accepting and/or rejecting images to ensure that all documents are accounted for

• When an image is unreadable (e.g. folded corners or tears) or askew, select the Rescan Later button and refer to the Capture QRG section “Rescanning a Document”

• If an image is missing, refer to the Capture QRG section “Adding a Missed Page”

• When an image is upside down or on its side, rotate the image and SAVE the rotation prior to accepting the image

• Prior to rejecting a blank page, scroll to the bottom to ensure that there is nothing noted on the image

• When scanned images contain vertical lines, delete the batch, clean the scanner, and rescan the batch

4. Indexing

• If Batch by Category

• When proceeding through the batch, verify that all fields are completed and match the information found on the Case Document Separator Sheet

• If Batch by Case

• Verify that the index fields match the information found on the Case Batch Header Sheet

• Ensure that the Category, Subcategory, and Doc Type index fields are correct before advancing to the next fastener

STEP ACTION



19.9.1 Scanning Tips

Refer to these instructions when submitting paperwork to scanning. Also use the following documents on the SSA under “Department”- “Quick Links” and for complete IDM processing information:

• Applications• IDM Retrieval Application• IDM Barcode Generator

• Training Materials

• Document Preparation & Barcode Quick Reference Guide• Modify IDM Retrieval Quick Reference Guide• IDM Capture Quick Reference Guide• IDM Quality Assurance Process• IDM End Use Documentation• IDM Retrieval Quick Reference Guide

5. Quality Assurance (QA) using Retrieval

• Verify that EACH document in the batch is accounted for in Retrieval

• Search for the case by using the CalWIN Case Number or the SSN as indicated on either the Case Batch Header Sheet or the Case Document Separator Sheet

• Click on the scanned image to open the document• Verify the document page by page to ensure that no pages are missing or

unreadable• Ensure that documents for different cases have not been imaged together by

checking that all pages in the document relate to the specific client or case

- If any of the above-listed problems occur, the imaged document must be modified.- Contact the OMC or Lead who has been assigned the security access to edit the index

so that the imaged document will be removed from the case- Rescan the document

• If the document has been indexed incorrectly, contact the OMC or Lead to correct the index properties

6. Destruction of Documents

• After a batch has been properly QAed:

• Store the batch by date• Burn bag the documents after 30 days

REMINDER: ALL OF THE ACTIONS IN STEPS # 1 THROUGH #5 MUST BE TAKEN BEFORE ANY DOCUMENTS CAN BE DESTROYED.

STEP ACTION



IDM quality assurance is supported when you:

• Use black or blue ink on all of your correspondence• Ask clients to use black or blue ink on all of their correspondence• Remind clients NOT to use pencil or metallic or neon inks on documents• Use only yellow high lighter• Be sure to apply enough pressure to all NCR an carbon copy forms• Make sure all paperwork has the correct case number on it (and Social Security

Number for Welfare-to-Work paticipants).• When copying Social Security cards and photo IDs, you must use the Photo/Text

feature on the copier.

19.10Client Access to IDM Documents

Under Welfare and Institutions codes, applicants, recipients and their authorized representatives (AR) are entitled to have full access to their case records. Therefore, ALL documents stored in IDM, except privileged documents, must be made available for the client to review upon request.

If a client requests to see their full case record, the EW/ET must print and give a hard copy of all documents, except for privileged documents, stored in IDM to the applicant, recipient or their authorized representative. If there is any question whether a document is privileged, the Program Unit is to be contacted for guidance.

19.10.1 Privileged Document

The possibility of privilege exists only if information about the applicant/recipient comes to the Social Services Agency from a third party, without the applicant/recipients permission. In a case containing only one adult or head of household, this would include information such as the whereabouts of an absent parent (provided by a Child Support Agency) or private information concerning the status of children who might have been removed from the home by Child Protective Services. It also includes Community Complaints where the complainant has requested anonymity. The SCD 16 is NOT to be copied and given to the client.

Other instances or examples of potential privileged, private or confidential information include cases containing information about multiple adults or heads of households.



Example:Mother and her child receive CalWORKs in one case. Her 19-year old daughter and her child receive CalWORKs in another case. They all receive CalFresh in the mother’s case. The mother requests to see her case record. Any information, verifications or forms the daughter provided would be considered privileged.

Even routine information provided by one adult to the Agency or SSA may be privileged in regard to another adult in the home (or formerly in the home). This could include information such as medical history or criminal background.

Example:Mother requests to see the case record. The father who was previously in the home is now an absent parent. Any information he provided while in the home such as employment records, medical records, drug felony conviction records, etc are considered privileged and must NOT be copied and given to the mother.

Reminder:If there is any question of whether a document is privileged, Program is to be contacted for a determination. County Counsel is available to advise the Program Unit on legal matters.

For more information, [Refer to “Client/Third Party Case Reviews,” page 42-1].

19.11 Miscellaneous IDM Procedures

19.11.1 Scanning of New Intake Documentation

The IDM Barcode Generator application uses the information in the DEBS lookup table to create the case barcode sheet. The lookup table is populated each evening with data entered into CalWIN during the day.

Documents (e.g. “Identification and Intake Record” (SCD41) and SAWS 1) received on the date of application for NEW CalWIN cases cannot be scanned into the IDM system until the next day. In these cases, documents are to be imaged the first thing in the morning the day after the receipt of the documents.



19.11.2 Scanning Request Submission Requirement

All documents submitted for scanning must have either the CalWIN case number or SSN written visibly on the document or must have the CalWIN Display Individual Demographics Summary attached.

19.11.3 IDM Retrieval Problem

Users are unable to retrieve all the documents stored in the IDM system for a case that has a different case number for CalWIN and CDS. The following happens if the user enters the case number as a search criteria on the Document Retrieval window:

• If the CalWIN # is entered – only documents related to the CalWIN # will be displayed.

• If the CDS # is entered – only documents related to the CDS # will be displayed.

• If both the CalWIN & CDS #s are entered – no document will be retrieved; user will receive a message stating “There are no documents for this criteria.”

The IDM system does not have the capability to cross reference the old CDS number with the new CalWIN case number. Therefore, the user must use the client’s SSN or name and date of birth when completing the search request on the [Document Retrieval] window.

19.11.4 Corrections to IDM Documents Index Fields

If a user discovers an error in IDM that needs to be corrected, the user must complete an “IDM DEBS Document Properties Change Request” (SCD 183) form and submit it to their District Office OMC to make the necessary correction(s).

19.11.5 Closed Case IDM Policy

A closed physical case that has not been scanned is to be sent to the Retention Center after the 1-month discontinuance period has ended. The Retention Center will file the physical case. All documentation received for the case after the case has been sent to the Retention Center MUST be scanned by District Office staff and then destroyed.



The Retention Center will take action as per the following chart.

If the case has . . . Then . . .

Been Partially Scanned, The documents MUST be scanned into the IDM system by District Office staff.

NOT been scanned, The documents are to be filed in the physical case.

19.11.6 IDM Access by Non Social Service Agency Staff

The Central Intake Unit which handles the employment services for refugees has both scanning and retrieval access to the IDM system.

The Social Services Agency is required under law or through agreements to share documents with certain other agencies. In order to meet this requirement, these other agencies have been granted “view and print” only access to the IDM system. These agencies include:

• District Attorney’s Office - Fraud Division• Local Department of Child Support Services (DCSS)• Native TANF workers

19.12Benefits Forms Cross Reference Chart

The following chart lists in numeric order the most common Benefit forms which are scanned into the IDM system and identifies the category/sub-category under which the form is scanned. This chart is not all inclusive. If a form is not located in this chart, the program liaison may contact the respective program coordinator to inquire the reason.

FORM NUMBER CATEGORY SUB-CATEGOROY

CA 82 PERMANENT VERIFICATION


CS 9 BENEFITS F2 - CASE VERIF/CHILD SUPPORT

CSF 2 BENEFITS F2 - CASE VERIF/CHILD SUPPORT





CSF 18 PERMANENT VERIFICATION


CSF 22 BENEFITS F1 - APPLICATION



CSF 32 REPORTS/INCOME BENEFITS

CSF 34 REPORTS/INCOME BENEFITS












CW 2.1 BENEFITS F2 - CASE VERIF/CHILD SUPPORT

CW 2.1Q BENEFITS F2 - CASE VERIF/CHILD SUPPORT

CW 5 BENEFITS F2 - CASE VERIF/CHILD SUPPORT

CW 8 BENEFITS F1 - APPLICATION

CW 8A BENEFITS F1 - APPLICATION



CW 42 PERMANENT VERIFICATION





CW 215 BENEFITS F6 - MISC/COURT REVIEW/OP/OI












CW 2186A PERMANENT VERIFICATION





CWC 6041 BENEFITS F5 - CALFRESH/MEDI-CAL

DFA 285-A1 BENEFITS F1 - APPLICATION



DFA 285B BENEFITS F5 - CALFRESH/MEDI-CAL OR F6 - MISC/COURT REVIEW/OP/OI - IF FORM COMPLETED BY CROP/IEVS

DFA 285C BENEFITS F5 - CALFRESH/MEDI-CAL OR F6 - MISC/COURT REVIEW/OP/OI - IF FORM COMPLETED BY CROP/IEVS

DFA 377.7C BENEFITS F6 - MISC/COURT REVIEW/OP/OI

DFA 386 BENEFITS F5 - FOOD STAMPS/MEDI-CAL

DFA 842 BENEFITS F6 - MISC/COURT REVIEW/OP/OI

DHCS 7077

DHS 6155 BENEFITS F5 - FOOD STAMPS/MEDI-CAL

DHS 7068 BENEFITS F1 - APPLICATION

ECS 155 BENEFITS F2 - CASE VERIF/CHILD SUPPORT

FC 2 BENEFITS F1 - APPLICATION

FC 4 BENEFITS F1 - APPLICATION

FS 26 BENEFITS F1 - APPLICATION

FS 27 BENEFITS F1 - APPLICATION




GA 1 BENEFITS F1 - APPLICATION

GA 2 BENEFITS F2 - CASE VERIF/CHILD SUPPORT



GA 9 BENEFITS VSS - TRAINING ATTENDANCE


GA 16 BENEFITS F6 - MISC/COURT REVIEW/OP/OI

GA 17 BENEFITS F6 - MISC/COURT REVIEW/OP/OI

GA 30 BENEFITS VSS - JOB SEARCH

GA 68 BENEFITS VSS - WORK PROJECT


G 845 PERMANENT VERIFICATION


MC 13 PERMANENT VERIFICATION


MC 61 BENEFITS F2 - CASE VERIF/CHILD SUPPORT

MC 175-1 BENEFITS F1 - APPLICATION

MC 175-2 BENEFITS F1 - APPLICATION

MC 175-3I.2A BENEFITS F5 - FOOD STAMPS/MEDI-CAL

MC 175-3I.2R BENEFITS F5 - FOOD STAMPS/MEDI-CAL

MC 176 Series BENEFITS F5 - FOOD STAMPS/MEDI-CAL

MC 176 S REPORTS/INCOME BENEFITS

MC 176 TMC REPORTS/INCOME BENEFITS



MC 210 BENEFITS F1 - APPLICATION

MC 210A BENEFITS F1 - APPLICATION

MC 210B BENEFITS F1 - APPLICATION

MC 210RV BENEFITS F1 - APPLICATION








MC 224A BENEFITS F6 - MISC/COURT REVIEW/OP/OI

MC 224B BENEFITS F6 - MISC/COURT REVIEW/OP/OI

MC 239 BENEFITS F5 - FOOD STAMPS/MEDI-CAL




MC 321 HFP BENEFITS F1 - APPLICATION

MC 355 BENEFITS F5 - FOOD STAMPS/MEDI-CAL


MC 609 BENEFITS F6 - MISC/COURT REVIEW/OP/OI




QR 3 REPORTS/INCOME BENEFITS


QR 22 BENEFITS F1 - APPLICATION



QR 285B BENEFITS F5 - CALFRESH/MEDI-CAL OR F6 - MISC/COURT REVIEW/OP/OI - IF FORM COMPLETED BY CROP/IEVS

QR 377.5 REPORTS/INCOME BENEFITS

RS 36 BENEFITS F1 - APPLICATION

SAWS 1 BENEFITS F1 - APPLICATION

SAWS 2 BENEFITS F1 - APPLICATION

SAWS 2A BENEFITS F1 - APPLICATION

SCD 11 BENEFITS F6 - MISC/COURT REVIEW/OP/OI

SCD 15 BENEFITS F2 - CASE VERIF/CHILD SUPPORT





SCD 22 BENEFITS F1 - APPLICATION



SCD 46 PERMANENT VERIFICATION


SCD 50/SCD 50A BENEFITS F6 - MISC/COURT REVIEW/OP/OI


SCD 54A BENEFITS F6 - MISC/COURT REVIEW/OP/OI








SCD 93A SCD 93B SCD 93C SCD 93D

BENEFITS F1 - APPLICATION







SCD 111A BENEFITS F2 - CASE VERIF/CHILD SUPPORT














SCD 274 BENEFITS F4 - LMO / SCD163 / FIN / CW / GA





SCD 380 REPORTS/INCOME BENEFITS





















SCD 1233 BENEFITS F5 - FOOD STAMPS/MEDI-CAL













SCD 1296 BENEFITS MEDS














SCD 1527 BENEFITS VSS - JOB SEARCH



SCD 1564 REPORTS/INCOME BENEFITS






















SCD 1931 A BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SCD 1931 B BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SCD 1931 C BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SCD 1931 P BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SCD 1931 SNEEDE A

BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SCD 1931 SNEEDE R

BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SCD 1931 V BENEFITS F5 - FOOD STAMPS/MEDI-CAL




SCD 2251 BENEFITS PERMANENT VERIFICATIONS


SCD 2384 BENEFTIS F5 - FOOD STAMPS/MEDI-CAL

SCD EBT 1 BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SCD EBT 2 BENEFITS F1 - APPLICATION

SCD EBT 3 PERMANENT VERIFICATION


SCD EBT4 PERMANENT VERIFICATION


SCD EBT 5 BENEFITS F1 - APPLICATION




19.13CWES FORMS CROSS REFERENCE CHART

The following chart lists in numeric order the most common CWES forms which are scanned into the IDM system and identifies the category/sub-category under which the form is scanned

SCD EBT 6 BENEFITS F5 - FOOD STAMPS/MEDI-CAL

SOC 155 BENEFITS F6 - MISC/COURT REVIEW/OP/OI

SOC 453 BENEFITS F1 - APPLICATION

SOC 455 PERMANENT VERIFICATION






SSP 14 PERMANENT VERIFICATION



CCP7 CWES F4 - CHILD CARE

CD 7617 CWES F4 - CHILD CARE

CD 9600 CWES F4 - CHILD CARE

CL 1 CWES CL/T - REGISTRATION/ORIENTATION


CL 3 CWES CL/T - CORR/DISCONTIN/NONCOMP


CL 9 CWES CL/T - CORR/DISCONTIN/NONCOMP




CL 10 CWES CL/T - SCHOOL VERIF/ATTENDANC

CSF 1 CWES F5 - SUPPORTIVE SERVICES

CSF 6 CWES F10 - OTHER CORRESPONDENCE

CSF 7 CWES F6 - WTW AGREEMENTS OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

CSF 22 CWES F9 - EMPLOYMENT VERIFICATION OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

CSF 32 CWES F6 - WTW AGREEMENTS

CSF 37 CWES F6 - WTW AGREEMENTS

CW 61 CWES F7 - GOOD CAUSE/EXEMPTIONS OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

CW 61A CWES F7 - GOOD CAUSE/EXEMPTIONS OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

CW 61B CWES F7 - GOOD CAUSE/EXEMPTIONS OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

CW 2186 A CWES F7 - CALWORKS TIME LIMIT AND WELFARE TO WORK PARTICIPATION REQUEST FORM

CW 2186 B CWES F7- CALWORKS AND WELFARE TO WORK TIME LIMIT EXEMPTION DETERMINATION

FSP 2 CWES F5 - SUPPORTIVE SERVICES

FSP 3 CWES F5 - SUPPORTIVE SERVICES

gis 102s CWES F10 - OTHER CORRESPONDENCE




NA 820 CWES F5 - SUPPORTIVE SERVICES OR CL/T - SUPPORTIVE SERVICES IF CAL-LEARN/TEEN PARENT





NA 825 CWES F5 - SUPPORTIVE SERVICES

NA 832 CWES F4 - CHILD CARE




NA 840 CWES F8 - NON-COMPLIANCE OR CL/T - CORR/DISCONTIN/NONCOMP IF CAL-LEARN/TEEN PARENT

NA 840A CWES F8 - NON-COMPLIANCE OR CL/T - CORR/DISCONTIN/NONCOMP IF CAL-LEARN/TEEN PARENT

NA 841 CWES F8 - NON-COMPLIANCE

NA 843 CWES CL/T - CORR/DISCONTIN/NONCOMP

NA 844 CWES CL/T - SCHOOL VERIF/ATTENDANCE




NA 845 CWES F8 - NON-COMPLIANCE OR CL/T - CORR/DISCONTIN/NONCOMP IF CAL-LEARN/TEEN PARENT

NA 1276 CWES F-10 END OF WTW 24-MONTH TIME CLOCK

SCD 24 CWES F10 - OTHER CORRESPONDENCE

SCD 29 CWES F6 - WTW AGREEMENTS

SCD 50 CWES F10 - OTHER CORRESPONDENCE OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

SCD 54 CWES F2 - APPLICATION

SCD 62 CWES CL/T - CORR/DISCONTIN/NONCOMP (IF DUE TO PENALTY) OR CL/T - SCHOOL VERIF/ATTENDANCE (IF DUE TO LACK OF ADEQUATE OR SATISFACTORY PROGRESS)

SCD 72 CWES CL/T - SUPPORTIVE SERVICES


SCD 101 A CWES F10 - GENERAL AFFIDAVIT - CONT.


SCD 163 CWES F3 - CONTACT-ACTION SUMMARY

SCD 325 CWES F10 - Employed Letter


SCD 382 CWES F5 - SUPPORTIVE SERVICES

SCD 383 CWES CL/T - SUPPORTIVE SERVICES

SCD 473 CWES F8 - NON-COMPLIANCE OR CL/T - CORR/DISCONTIN/NONCOMP IF CAL-LEARN/TEEN PARENT

SCD 501 CWES F8 - NON-COMPLIANCE




SCD 511 CWES F4 - CHILD CARE


SCD 549 CWES F9 - EMPLOYMENT VERIFICATION OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT


SCD 723 CWES F5 - SUPPORTIVE SERVICES OR CL/T - SUPPORTIVE SERVICES IF CAL-LEARN/TEEN PARENT







SCD 1302 CWES F6 - WTW AGREEMENTS OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT


SCD 1415 CWES F4 - Child Care Receipt











SCD 1715 CWES F7 - GOOD CAUSE/EXEMPTIONS






SCD 1755 (See next line for exception)

REPORTS/INCOME CWES

SCD 1755 (FOR CAL-LEARN/ TEEN PARENT

CWES CL/T - SCHOOL VERIF/ATTENDANCE



SCD 1757A CWES F6 - WTW AGREEMENTS OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT








SCD 1764B CWES F6 - WTW AGREEMENTS




SCD 1768A CWES F6 - WTW AGREEMENTS

SCD 1771 CWES F2 - APPLICATION OR CL/T - REGISTRATION/ORIENTATION IF CAL-LEARN/TEEN PARENT




SCD 1777A CWES F4 - CHILD CARE







SCD 1782 CWES F7 - GOOD CAUSE/EXEMPTIONS OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

SCD 1783 CWES F10 - OTHER CORRESPONDENCE OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT






SCD 1799A CWES F5 - SUPPORTIVE SERVICES




SCD 1818 CWES F9 - EMPLOYMENT VERIFICATION OR CL/T - SCHOOL VERIF/ATTENDANCE IF CAL-LEARN/TEEN PARENT

SCD 1838 CWES F9 - EMPLOYMENT VERIFICATION










SCD 2169A CWES F9 - EMPLOYMENT VERIFICATION

SCD 2272 CWES F-10 - INDIVIDUAL INTAKE REQUEST





SCD 2392 CWES F6- WTW AGREEMENTS

SCD 2416 CWES F5- SUPPORTIVE SERVICES


SCD 2418-A CWES F6 - WTW AGREEMENTS

SCD 2418-B CWES F6 - WTW AGREEMENTS


W-9 CWES F4 - CHILD CARE

WTW 1 CWES F6 - WTW AGREEMENTS OR CL/T - REGISTRATION/ORIENTATION IF CAL-LEARN/TEEN PARENT






WTW 4 CWES F8 - NON-COMPLIANCE


WTW 9 CWES F2 - APPLICATION


WTW 11 CWES F10 - OTHER CORRESPONDENCE

WTW 12 CWES F10 - OTHER CORRESPONDENCE

WTW 15 CWES F6 - WTW AGREEMENTS




WTW 27 CWES F8 - NON-COMPLIANCE OR CL/T - CORR/DISCONTIN/NONCOMP IF CAL-LEARN/TEEN PARENT


WTW 32 CWES F8 - NON-COMPLIANCE OR CL/T - CORR/DISCONTIN/NONCOMP IF CAL-LEARN/TEEN PARENT










19.14 Foster Care Forms Cross Reference Chart

The following chart lists in numeric order the most common Foster Care forms which are scanned into the IDM system and identifies the category/sub-category under which the form is scanned.

FORM NUMBER CATEGORY SUB-CATEGORY

AAP 1 FOSTER CARE F3 - INITIAL DETERMINATION


AAP 3 FOSTER CARE F5 - PLACEMENT/PAYMENT


AB 882 FOSTER CARE F1 - APPLICATIONS

AB 3632/882 FOSTER CARE F1 - APPLICATIONS

ACE 1 FOSTER CARE F1 - APPLICATIONS

AD 907 FOSTER CARE F9 - CONFIDENTIAL/OTHER COURT DOCS

AD 4320 FOSTER CARE F5 - PLACEMENT/PAYMENT

ADOPT 215 FOSTER CARE F9 - CONFIDENTIAL/OTHER COURT DOCS

ARC 1 FOSTER CARE F1 - APPLICATIONS

CA 1 FOSTER CARE F1 - APPLICATIONS

CA 5 FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT

CW 2.1 FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT

CW 2.1Q FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT

CW 51 FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT

CW 215 FOSTER CARE F1 - APPLICATIONS

CW 371 FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT



DHS 6155 FOSTER CARE F8 - MEDS

EA 1 FOSTER CARE F1 - APPLICATIONS

FC 2 FOSTER CARE F1 - APPLICATIONS

FC 3 FOSTER CARE F3 - INITIAL DETERMINATION

FC 3A FOSTER CARE F3 - INITIAL DETERMINATION

FC 4 FOSTER CARE F2 - PERMANENT VERIFICATIONS

FC 8 FOSTER CARE F2 - PERMANENT VERIFICATIONS

FC 10 FOSTER CARE F3 - INITIAL DETERMINATION

FC 18 FOSTER CARE F1 - APPLICATIONS

FC RU FOSTER CARE F3 - INITIAL DETERMINATION

ICAMA 6.03 FOSTER CARE F1 - APPLICATIONS



ICAMA 7.02b FOSTER CARE F1 - APPLICATIONS


ICAMA 7.05b FOSTER CARE F1 - APPLICATIONS

IEVS 410 FOSTER CARE F3 - INITIAL DETERMINATION

JV 100 FOSTER CARE F3 - INITIAL DETERMINATION

JV 640 FOSTER CARE F3 - INITIAL DETERMINATION

KG 1 FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT

KG 2 FOSTER CARE F1 - APPLICATIONS

KG 2A FOSTER CARE F1 - APPLICATIONS

MC 13 FOSTER CARE F2 - PERMANENT VERIFICATIONS

MC 194 FOSTER CARE F2 - PERMANENT VERIFICATIONS

MC 250 FOSTER CARE F1 - APPLICATIONS

MC 355 FOSTER CARE F7 - CORRESPONDENCE/EMAILS



NA 1261 FOSTER CARE F10 - NOAS

NA 1261A FOSTER CARE F10 - NOAS




NA 1261B FOSTER CARE F10 - NOAS

QR 7* FOSTER CARE F3 - INITIAL DETERMINATION

SAWS 1* FOSTER CARE F1 - APPLICATIONS

SAWS 2 FOSTER CARE F1 - APPLICATIONS

SAWS 2A/JA 2 FOSTER CARE F1 - APPLICATIONS

SCD 13 FOSTER CARE F6 - BENEFIT ISSUANCE / RECOVERY / APPEALS

SCD 30 FOSTER CARE F5 - PLACEMENT / PAYMENT


SCD 37 FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT

SCD 38 FOSTER CARE F1 - APPLICATIONS

SCD 50 FOSTER CARE F7 - CORRESPONDENCE/EMAILS

SCD 53 FOSTER CARE F8 - MEDS


SCD 58 FOSTER CARE F2 - PERMANENT VERIFICATIONS

















SCD 688 FOSTER CARE F5 - PLACEMENT/PAYMENT








SCD 1296 FOSTER CARE F8 - MEDS




SCD 1533 FOSTER CARE F3 - INITIAL DETERMINATION


SCD 1707 FOSTER CARE F3 - INITIAL DETERMINATION



SCD 2249 FOSTER CARE F5 - PLACEMENT/PAYMENT

SCD FC 41 FOSTER CARE F1 - APPLICATIONS

SCZ 4 FOSTER CARE F5 - PLACEMENT/PAYMENT

SCZ 4a FOSTER CARE F5 - PLACEMENT/PAYMENT

SCZ 63 FOSTER CARE F1 - APPLICATIONS





SCZ 200G FOSTER CARE F2 - PERMANENT VERIFICATIONS

SCZ 263 FOSTER CARE F1 - APPLICATIONS

SCZ 263B FOSTER CARE F1 - APPLICATIONS

SCZ 414A/D FOSTER CARE F5 - PLACEMENT/PAYMENT





SCZ 1679c FOSTER CARE F5 - PLACEMENT/PAYMENT

SOC 152 FOSTER CARE F5 - PLACEMENT/PAYMENT

SOC 155 FOSTER CARE F3 - INITIAL DETERMINATION

SOC 155B FOSTER CARE F5 - PLACEMENT/PAYMENT

SOC 157A FOSTER CARE F5 - PLACEMENT/PAYMENT

SOC 158A FOSTER CARE F5 - PLACEMENT/PAYMENT




SOC 369 FOSTER CARE F1 - APPLICATIONS

SOC 369B FOSTER CARE F1 - APPLICATIONS






SS 5 FOSTER CARE F2 - PERMANENT VERIFICATIONS

SSA 11BK FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT

SSA/SSI 1633 FOSTER CARE F4 - CASE VERIFICATIONS/CHILD SUPPORT



