19. Integrated Document Management (IDM) · Common Place 19. Integrated Document Management (IDM) Page 19-2 Update #19-12 8. All third party verifications whether on own stationery

Medi-CalCommon Place 19. Integrated 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.

19.1.1 Benefit and CWES Cases

All Benefit and CWES 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.

19.1.2 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/recertification 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 Eligibility Limited Services” (MC 4026) form.

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

7. Any correspondence and verifications received from the client.

Update #19-12Page 19-1

page 19-2Common Place 19. Integrated Document Management (IDM)

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 Child Support 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.

19.1.3 CWES Cases

All CWES documents (including shelf stock issued NOAs) as identified for an active ES case. [Refer to “Category/Sub-Category - CWES Chart,” page 19-11] for a listing of CWES documents which need to be imaged.]

19.1.4 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 19-15] for a listing of SSI Advocacy documents which need to be imaged].

19.2 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 be 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:



Table 19-1:

• PERMANENT VERIFICATION

• REPORTS/INCOME -BENEFITS-CWES

• BENEFITS-F1 - APPLICATION-F2 - CASE VERIF / CHILD SUPPORT-F3 - 278F (no longer used)-F4 - LMO /FIN CW / GA (no longer used) -F5 - CALFRESH / MEDI-CAL-F6 - MISC- COURT REVIEW / OP / OI DOCS-MEDS-VSS - JOB SEARCH-VSS - TRAINING ATTENDANCE-VSS - WORK PROJECT

• CWES-F1 - SCREEN SHOTS-F2 - APPLICATION-F3 - CONTACT ACTION SUMMARY (no longer used)-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.



19.3 Category/Subcategory - Benefits

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

Table 19-2:

CATEGORY SUB-CATEGORY

DOCUMENTS TO BE SCANNED UNDER THIS CATEGORY/SUB-CATEGORY

PERMANENT VERIFICATION

PERMANENT VERIFICATION

• Photo ID, Driver’s license, SSN, USCIS documents (front and back), SFIS – birth, death, marriage certificates• CA 74 - Permanent Housing Search Document• CA 82 - Agreement to Sell Property• CSC 99 - Non-MAGI Informing Letter• CSF 31 - Request for Discontinuance/Withdrawal/Waiver• CSF 65 - Electronic Benefit Transfer (EBT) Exemption from Cash Stagger• CSF 66 - Electronic Benefit Transfer (EBT) Exemption from Cash• CW 42 - Statement of Facts - Homeless Assistance• CW 2102 - The Maximum Family Grant Rule for Recipients of Cash Aid

(obsolete)• CW 2168 - CalWORKs and Welfare to Work Determination (obsolete)• CW 2184 - CalWORKs 60-Month Time Limit• CW 2186A - CalWORKs and Welfare to Work Time Limit Exemption Request• CW 2188 - Verification of Aid for the TANF Program• CW 2223 - Demographics Questionnaire• 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 LA - Disability Determination and Transmittal• MC 330 - Newborn Referral• 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• SAVE - Request and Response Form



REPORTS / INCOME

BENEFITS • All Status Reports and any documentation that is received with these reports. • AR 2 SAR- Reporting Changes for CalWORKs and CalFresh• AR 3 - Mid-Year Status Report for CalWORKs and CalFresh• CSF 34 - Daily Tip Statement• CSF 35 - Self-Employment Sworn Statement• MC 176TMC - Transitional Medi-Cal (TMC) Status Report (Quarterly)• SAR 2 - Reporting Changes for Cash Aid and CalFresh• SAR 3 - Mid Quarter Status Report• SAR 7 - Eligibility/Status Report• SAR 72 - Sponsor’s Semi-Annual Income and Resources Report• SAR 73 - Senior Parent Semi-Annual Income Report• SAR 377.5 - Food Stamp Mid-Certification Status Report

Table 19-2:





BENEFITS • F1 - APPLICATION

For Active Benefits Cases:• ARC 1 - Statement of Facts Supporting Eligibility for ARC• CCFRM 604 - Application for Health Insurance• CF 37 - Recertification For CalFresh Benefits• CF 285 - Application for CalFresh• CSF 6 - Appointment Letter for Public Assistance• CSF 22 - Employment Questionnaire• CSF 67 - Electronic Benefit Transfer (EBT) Card and PIN Responsibility

Statement• 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 (obsolete)• CW 2200 - Request for Verification• CW 2200 GA - Request for Verification• CW 2208 - Your WTW 24-Month Time Clock• CW 2223 - Demographics Questionnaire• CW 2224 - CalWORKs Home Visiting Initiative Informing and Opt-In• DHCS 7077 - Notice Regarding Standards for Medi-Cal Eligibility• DHCS 7077A - Notice Regarding Transfer of a Home for Married and

Unmarried Applicant/Beneficiary• DHS 7068 - Responsibilities of Public Guardians/Conservators or

Applicant/Beneficiary Representatives• DHS 7096 - Department of Developmental Services Waiver Referral (obsolete)• FC 2 - Statement of Facts Supporting Eligibility for AFDC - Foster Care• FC 4 - Foster Child Program Choice Indication• FS 26 - Food Stamp Program Qualifying Drug Felon Addendum (obsolete)• FS 27 - Non-Assistance Food Stamp (NSFS) Household Recertification Form

(obsolete)• 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 210 SW- Employment Questionnaire• MC 212 - Medi-Cal Residency Declaration

(CONTINUED ON NEXT PAGE)

Table 19-2:





BENEFITS • F1 - APPLICATION (Continued)

• MC 219 - Important Information for Persons Requesting Medi-Cal• MC 223 - Applicant’s Supplemental Statement of Facts for Medi-Cal• MC 239 SN-3- Excluded Child Statement• 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 371 - Additional Family members Requesting Medi-Cal• MC 604 IPS - MC 604 IPS Evaluation for Non-MAGI Medi-Cal• MC 604 MDV - Doctor’s Verification Form• MC 4026 - Request for Eligibility Limited Services• RS 36 - Employment & Training Requirements for Refugee Cash Assistance• SAR 22 - Sponsored Noncitizens Applying for or Receiving Cash Aid and/or

CalFresh• SAWS 1 - Initial Application for CalFresh, Cash Aid and/or Medi-Cal/Health

Care Programs• SAWS 2 Plus- Application for CalFresh, Cash Aid and/or Medi-Cal/Health Care

Programs• SAWS 2A SAR - Rights, Responsibilities and Other Important Information• CSF 64 - Electronic Benefit Transfer (EBT) Request for Additional Cardholder• CSF 67 - Electronic Benefit Transfer (EBT) Card and PIN Responsibility

Statement• 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

Table 19-2:





BENEFITS • F2 - CASE VERIF / CHILD SUPPORT

• CF 10 - Dependent Care Cost Affidavit• CS 909 - Declaration of Paternity• CSC 31 - Employment Verification When Job Ends• CSF 2 - General Affidavit• CSF 19 - Child Care Receipt• CSF 23 - Statement of Gift/Loan• CSF 25 - Special Diet Request• CSF 27 - Insurance Verification• CSF 28 - Pregnancy Verification• CSF 30 - Receipt For Documents• CSF 33 - Notice to Self-Employed Individuals• CSF 37 - School Attendance Verification• CSF 46 - Immunization Status Record• CSF 47 - Housing Statement/Verification• 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 74 - Permanent Housing Search Document• CW 371 - Referral to DA for Action on CalWORKs Parent• Absent Parent - Memos to Social Services• All Refugee forms• Court Letter - District Attorney Letter to report to court• Paternity - Memos addressed to DA or Child Support• IEVS Child Support Affidavit packets• The most recent:

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

Table 19-2:





BENEFITS • F4 - LMO / FIN / CW / GA

• CCP 7 - CalWORKs Stage One Child Care Request Form And Payment Rules• LMO - 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

BENEFITS • F5 - CALFRESH / MEDI-CAL

CalFresh/CalWORKs Forms:• CF 29 - CalFresh Recertification Appointment Letter• CF 285 - Application for CalFresh Benefits• CF 386 - Notice of Missed Interview• NOAs - ALL hand written CalFresh 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• DDSD Referral Packet (MC 220, MC 221)• Medical Expense receipts for CalFresh since last RC

Table 19-2:





BENEFITS F6 - MISC/ COURT REVIEW / OP / OI

• CF 32 - CalFresh Request for Contact• CF 377.1 - Notice of Approval for CalFresh Benefits• CF 377.4 SAR - CalFresh Notice of Change for Semi-Annual Reporting

Households• CF 377.7C - CalFresh Repayment Agreement• CF 387 - CalFresh Request For Information• CSF 6 - Appointment Letter For Public Assistance• CSF 63 - Official Payment Reciept• CW 215/MC 360 - Notification of Inter-County Transfer• DFA 377 1A - Notice of Denial or Pending Status (SSI)• DFA 377 1 - CalFresh Notice of Approval• 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 354 - Medi-Cal Contact Update• MC 609 - Confidential Medi-Cal Complaint Report• SAR 90 - Reminder Letter• All communications from the DA & Collections • Correspondence - Clients notes, 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

• Fair Hearing Decision• The following forms completed by 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• Overpayment packets including all NOAs• IEVs IPV packets

BENEFITS MEDS • MEDS/CDB Exception Reports• MEDS/CDB Screen Prints

BENEFITS VSS - JOB SEARCH

• Related documents pertaining to each Job Search Form • GA 30 - General Assistance Job Search Control

BENEFITS VSS - TRAINING ATTENDANCE

• GA 9 - Public Works Project Job Assignment and Time Sheet• Related documents pertaining to each Work Project Assignment Time Sheet

GA 9

BENEFITS VSS - WORK PROJECT

• GA 68 - Monthly Attendance Report • Related documents including school verifications/class schedules

Table 19-2:





19.4 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:

Table 19-3:

CATEGORY SUB-CATEGORY DOCUMENTS 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. • Paycheck Stubs• SCD 2227 -Daily Wage Statement

CWES F1 - SCREEN SHOTS For use by Retention Center Only.• For Closed Cases: All documents under Fastener 1 of the case

folder.

CWES • F2 - APPLICATION For Active CWES Cases:• CalWORKS Client Health Alliance OCAT Screener Tool• OCAT Appraisal Summary Report (ASR)• CW 2224 - CalWORKs Home Visiting Initiative and Opt-In• 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•

CWES • F3 - CONTACT-ACTION SUMMARY

For Active CWES Cases:• For entries dated 7/98 and ongoing.• All documents regarding 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 2558 - One Day Child Care Voucher• W-9 - Request for Tax Player Identification Number & Certification

CWES • F5 - SUPPORTIVE SERVICES

For Active CWES Cases:• Ancillary Request: varies• Auto Insurance• Mileage Verification Documents• Receipts• Outreach Materials• Payment Vouchers• Family Services:

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

Status NOA• Transportation NOA:

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

• Warrant Replacement Forms• Work and Training Related NOA:

• NA823 - Ancillary Approval & Denial • SCD 2561 - Family Stabilization HMIS Survey• HMIS Client Consent to Data Collection & Release of Information

Table 19-3:




CWES • F6 - WTW AGREEMENTS

For Active CWES Cases• CalWORKs Home Visitation Initiative (HVI) Client Status Report• 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• Family Service Plans

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

For Active CWES Cases:• 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

Table 19-3:




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

CWES • F9 - EMPLOYMENT VERIFICATION

For Active CWES Cases:• CSF 22 - Employment Verification • Placement Information (from Employment Connection)

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

CWES • CL/T - REGISTRATION/ ORIENTATION

For Active Cal Learn and Teen Cases• CL1 - CalLearn Registration/Program Information/Orientation

Appointment Notice• CL 2 - CalLearn Program Requirements• CL 8 - CalLearn Notice of Report Card Submittal Schedule• 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

Table 19-3:




19.5 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 - SCHOOL VERIF/ ATTENDANCE

For Active Cal Learn and Teen Cases• 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• TBA Form Lab Classes• Verification of (school) enrollment

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

Table 19-4:


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

Table 19-3:




Note:

These subcategories require confidential worker IDM user profile.

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

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• General Assistance Program Request for Medical Information• Special Education School Reports

Table 19-4:




19.6 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.

Table 19-5:


FOSTER CARE

• F-1 APPLICATIONS • 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 2 - Statement of Facts Supporting Eligibility for

AFDC-FC• FC 18 - Inter-County Transfer form and other • 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• SOC 369 - Disclosure Form Kin-GAP • STEP TILP - Transitional Independent Living Plan• 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• SCZ 263B - Slot Request RISC Referral• SCZ 63 - SCC RISC Referral and Mental Health RCL

13/14 Youth Certification• SED Approval Letter*

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• 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 1 - Request for Adoption Assistance• AAP 4 - Eligibility Certification for AAP• 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• FC 10 - Income and Property Checklist AAP• 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• SOC 155 - Voluntary Placement Agreement• SOC 155B - Mutual Agreement for 18 year olds


Table 19-5:




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• Supplemental Child Support Paternity Affidavit• Social Security Administration (SSA) Award Letter• SSA/SSI - 1633 Forms Series• SSA 11BK - Request to be Selected as Payee

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

Table 19-5:




FOSTER CARE

• F-5 PLACEMENT / PAYMENT

• 1040 Tax Return• AAP 2 - AAP Payment Instructions• AAP 3 - Reassessment Information• AAP 6 - AAP Negotiated Benefit Amount & Approval• AAP 8 - Nonrecurring Adoption Expenses Agreement• ARC 2 - Approve ARC Redetermination• 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 7.5 - Information Exchange and

Additional Children• ICAMA Form 7.5b - Information for ICAMA

Administrator• documents in transfer packet• ICPC 100 - Interstate Compact Placement Request• ICPC 100B - Interstate Compact on the Placement of

Children Report on Child’s Placement Status• Intensive Treatment/Intensive Services Foster Care

Services (ITFCS/ISFC)• SCZ 685 - Services Rate Schedule• ISFC Referral

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

• RFA 05A- Resource Family Approval Certificate (initial)

• RFA 06 - RFA Approval Update• San Andreas Regional Center (SARC) - Dual Agency

Letter• SARC/DFCS Communication - AB 250 Joint Client

form


Table 19-5:




FOSTER CARE

• F-5 PLACEMENT / PAYMENT

• SCZ 4 - Dual Agency Rate and/or Supplement Authorization

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

• SCZ 2422 - Designated Payee of AAP• SCZ 414A / SCZ 414D - DFCS Special Funds

Request• SCZ 489 - Special Needs Attachment• SCZ 1328 - Authorization for Emergency Satellite

Home• SCZ 1679 - Special Care Increment• SOC 152 - THP Plus FC Provider Agreement• SOC 155B - Mutual Agreement for 18 year olds• SOC 157A - Supervised Independent Living

Placement (SILP) Approval & Placement Agreement• SOC 158A - Foster Care Child’s Data Record and

AFCD-FC Certification• SOC 161 - Six-Month Certification for EFC• SOC 162 - Mutual Agreement for EFC• SOC 163 - Voluntary Re-Entry Agreement for EFC• SOC 500 - Level of Care Digital Scoring Sheet• 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• DFCS Director’s Exception Blanket Approval for Wrap• 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

Table 19-5:




FOSTER CARE

• F-7 CORRESPONDENCE/ EMAILS

• Address change forms• Letters from adoptive parents• Letters from foster care providers• RRR Notices• Special Need Renewal notice

FOSTER CARE

• F-8 MEDS • DHS 6155 - Health Insurance Questionnaire• MEDS screens• MEDS tickets


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 • NA 791 - NOA for AAP• NOAS that were modified and not saved in CalWIN


Table 19-5:




19.7 Processing of Periodic Reports

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

• Semi-Annual Eligibility/Status Report (SAR 7)• Medi-Cal Midyear Status Report (MC 176 S)• Transitional Medi-Cal Quarterly Status Report (MC 176 TMC)• Semi-Annual Status Report (SAR 3).• Daily Tip Statement (CSF 34)• Income/Profit and Loss Statement (CSF 35/SCD 380)• Sponsor’s Semi-Annual Income & Resources Report (SAR 72)• Senior Parent’s Semi-Annual Income Report (SAR 73)

Processing Procedures

The SAR 7, 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:

Table 19-6:

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.Note:

The dates may differ if documents are not scanned on the same day they are received. The stamped date always supersedes the scanned date.

• 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. • 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.

4. District Office Clerical Staff

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

Table 19-6:

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.

19.8 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/Tools Apps/At the Office/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.

Table 19-7:

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

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

Table 19-7:

STEP ACTION



19.8.1 Scanning Tips

Refer to these instructions when submitting paperwork to scanning. Also use the following documents on the SSA Intranet 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

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 participants).• When copying Social Security cards and photo IDs, you must use the Photo/Text feature on the

copier.

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.

Table 19-7:

STEP ACTION



19.9 Client Access to IDM Documents

Under Welfare and Institutions codes, applicants, recipients and their authorized representatives (ARs) 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/EC 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.

19.9.1 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 (SCD 16) 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]].

19.10 Miscellaneous IDM Procedures

19.10.1 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.

19.10.2 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.

19.10.3 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.



19.10.4 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).

19.10.5 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.

Table 19-8:

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.

19.10.6 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.

19.11 Benefits 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.

Table 19-9:

FORM NUMBER CATEGORY SUB-CATEGOROY

CSF 2 BENEFITS F2 - CASE VERIF/CHILD SUPPORT



CSF 18 PERMANENT VERIFICATION 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 PERMANENT VERIFICATION







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






CW 2186A PERMANENT VERIFICATION PERMANENT VERIFICATION


CW 2200 REQUEST FOR VERIFICATION F-1 APPLICATION




CWC 6041 BENEFITS F5 - CALFRESH/MEDI-CAL

CF 285 BENEFITS F1 - APPLICATION

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

Table 19-9:





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 PERMANENT VERIFICATION

MC 13 PERMANENT VERIFICATION 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

Table 19-9:




MC 355 BENEFITS F5 - FOOD STAMPS/MEDI-CAL


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



SAR 3 REPORTS/INCOME BENEFITS


SAR 22 BENEFITS F1 - APPLICATION



SAR 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

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

SOC 453 BENEFITS F1 - APPLICATION

SOC 455 PERMANENT VERIFICATION PERMANENT VERIFICATION





SSP 14 PERMANENT VERIFICATION PERMANENT VERIFICATION

Table 19-9:




19.12 CWES 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

Table 19-10:


CCP7 CWES F4 - CHILD CARE

CD 7617 CWES F4 - CHILD CARE

CD 9600 CWES F4 - CHILD CARE

CL 1 CWES CL/T - REGISTRATION/ORIENTA-TION


CL 3 CWES CL/T - CORR/DISCONTIN/NON-COMP


CL 9 CWES CL/T - CORR/DISCONTIN/NON-COMP

CL 10 CWES CL/T - SCHOOL VERIF/ATTEN-DANC

CSF 1 CWES F5 - SUPPORTIVE SERVICES

CSF 6 CWES F10 - OTHER CORRESPONDENCE

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

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

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

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

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

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

CW 2224 CWES F1- APPLICATION

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




Table 19-10:





NA 825 CWES F5 - SUPPORTIVE SERVICES

NA 832 CWES F4 - CHILD CARE




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

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

NA 841 CWES F8 - NON-COMPLIANCE

NA 843 CWES CL/T - CORR/DISCONTIN/NON-COMP

NA 844 CWES CL/T - SCHOOL VERIF/ATTEN-DANCE

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

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

W-9 CWES F4 - CHILD CARE

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


Table 19-10:





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/NON-COMP IF CAL-LEARN/TEEN PARENT


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







Table 19-10:




19.13 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.

Table 19-11:

FORM NUMBER CATEGORY SUB-CATEGORY

AAP 1 FOSTER CARE F3 - INITIAL DETERMINATION

AAP 2 FOSTER CARE F5 - PLACEMENT/PAYMENT


AAP 4 FOSTER CARE F3 - INITIAL DETERMINATION



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

ARC 2 FOSTER CARE F5 - PLACEMENT/PAYMENT

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 2A 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 F5 - PLACEMENT/PAYMENT

ICAMA 7.01 FOSTER CARE F5 - PLACEMENT/PAYMENT


ICAMA 7.02b FOSTER CARE F5 - PLACEMENT/PAYMENT


ICAMA 7.05b FOSTER CARE F5 - PLACEMENT/PAYMENT

ICPC 100 FOSTER CARE F5 - PLACEMENT/PAYMENT

ICPC 100b FOSTER CARE F5 - PLACEMENT/PAYMENT

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

Table 19-11:




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

MC 360 FOSTER CARE F1 - APPLICATIONS

MC 845* FOSTER CARE F1 - APPLICATIONS

NA 791 FOSTER CARE FC 10 - NOAs

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

RFA 05A FOSTER CARE F5 - PLACEMENT/PAYMENT

RFA 06 FOSTER CARE F5 - PLACEMENT/PAYMENT

SAWS 1* FOSTER CARE F1 - APPLICATIONS

SAWS 2 FOSTER CARE F1 - APPLICATIONS

SAWS 2A/JA 2 FOSTER CARE F1 - APPLICATIONS

SCZ 688 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





Table 19-11:




SCZ 1679c FOSTER CARE F5 - PLACEMENT/PAYMENT


SOC 152 FOSTER CARE F5 - PLACEMENT/PAYMENT



SOC 155B FOSTER CARE F3 - INITIAL DETERMINATION

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


SOC 815* FOSTER CARE F5 - PLACEMENT/PAYMENT





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

STEP TILP PLAN FOSTER CARE F1 - APPLICATIONS

STEP TILP Vouchers/Invoices

FOSTER CARE F5 - PLACEMENT/PAYMENT

Wraparound Vouchers/Invoices

FOSTER CARE F5 - PLACEMENT/PAYMENT

Table 19-11:





Table 19-11:



