103-2          REQUEST FOR SERVICE  

A completed and signed request for service application is considered an identifiable application. When DPA Division of Public Assistance receives a request for service, the request must be registered in EIS Eligibility Information System to protect the benefit start date. Staff can refer to the HowWe Guide Addendum 1 (Statewide Request for Service Job Aid) for additional information on request for service. Certain situations when cases are registered as requests for service include the following:

An applicant comes in to a DPA Division of Public Assistance office and cannot stay to complete the entire application. The applicant may complete and sign page 7 of the GEN 50 C Application for Services and submit it as a request for service application except for all MAGI Modified Adjusted Gross Income Medicaid categories. If an applicant requests MAGI Modified Adjusted Gross Income Medicaid on page 7, the MAGI Modified Adjusted Gross Income Medicaid request will be registered as an application.

Note:

If using page 7 as a request for service for all programs except MAGI Modified Adjusted Gross Income Medicaid, staff will need to make a copy of page 7 and return the entire application form to the applicant.

• If the GEN 72 Eligibility Review Form is received in the month following case closure for any reason, the GEN 72 Eligibility Review Form can be used as an initial application form. Refer to MAGI Medicaid MS 806-3 for more information about renewal requirements for MAGI Modified Adjusted Gross Income Medicaid.

• If the GEN 72 Eligibility Review Form is received after the month following the end of the certification period, it is considered a request for service except for MAGI Modified Adjusted Gross Income Medicaid. Refer to MAGI Medicaid MS 806 and 806-3 for more information about application and renewal requirements for MAGI Modified Adjusted Gross Income Medicaid.

• A recipient submits a GEN 72 Eligibility Review Form to recertify for a specific program and requests to add another program to their case. The request is considered a request for service except for MAGI Modified Adjusted Gross Income Medicaid. If a recipient requests to add MAGI Modified Adjusted Gross Income Medicaid to an existing case, MAGI Modified Adjusted Gross Income Medicaid will be registered as an application.

Note:

Senior Benefits application must be registered as an application and not as a request for service. Refer to MS 126-2A for additional information about Senior Benefits' application process.

103-2 A.     REGISTERING AND FILING REQUEST FOR SERVICE APPLICATIONS

When an applicant submits page 7 of the GEN 50 C Application for Services that DPA accepts as a request for service, the rest of the GEN 50 C Application for Services is given back to the applicant to complete. Staff must date stamp the request for service application with the date of receipt, and register it on EIS Eligibility Information System. Date stamping the request for service application protects the date the applicant initially expressed the need for having their eligibility considered.

When a recipient submits a GEN 72 Eligibility Review Form after the month following the end of the certification period that DPA registers as a request for service, a GEN 50 C Application for Services must also be completed before DPA Division of Public Assistance can authorize benefits for the recipient.

Example:

Certification ends in October. The GEN 72 Eligibility Review Form received in December, which is after the month following the end of the certification period, is considered a late recertification and must be registered as a request for service. This example does not apply to MAGI Modified Adjusted Gross Income Medicaid. Refer to MAGI Medicaid MS 806-3 for more information about late renewals for MAGI Modified Adjusted Gross Income Medicaid.

When a recipient submits a GEN 72 Eligibility Review Form and requests to add another program to their case, the request must be registered as a request for service except for MAGI Modified Adjusted Gross Income Medicaid. If a recipient requests to add MAGI Modified Adjusted Gross Income Medicaid to an existing case, MAGI Modified Adjusted Gross Income Medicaid will be registered as an application.  A GEN 50 C Application for Services must be completed before DPA Division of Public Assistance can authorize benefits for the recipient. A completed GEN 50 C Application for Services is not required for MAGI Modified Adjusted Gross Income Medicaid.

To register the request, staff must use the appropriate code:

• RA - Temporary Assistance

• RF - Supplemental Nutrition Assistance Program

• RP - Adult Public Assistance

• RG - Chronic and Acute Medical Assistance

• RR - General Assistance

103-2 B.     NOTICE AND INTERVIEW REQUIREMENT

DPA Division of Public Assistance will notify applicants who submit a request for service application of the interview requirement. Staff must send the N000 (APPLICATION RECEIVED - INTERVIEW NEEDED) notice the same day the request for service application is registered on EIS Eligibility Information System . The N000 notice informs the applicant of the receipt of their application, a reminder to complete the entire application packet, and the requirement to attend an interview.  

Note:  

The Supplemental Nutrition Assistance Program has specific and time-sensitive requirements for scheduling interviews and notifying clients about missed interviews.  See Food Stamp (SNAP) manual section 601-3.

103-2 C.     APPLICANT FAILS TO COMPLETE THE APPLICATION PROCESS

If an applicant fails to attend an interview and complete the application process, their application will be denied 30 calendar days after the application filing date (the application filing date is counted as zero). EIS Eligibility Information System will automatically deny the application and send the appropriate denial notice based on the programs the applicant requested to receive.

Note:

An interview is not required for MAGI Modified Adjusted Gross Income Medicaid.

103-2 D.     STORING REQUEST FOR SERVICE APPLICATIONS

Request for service applications are often stored in a file created specifically for request for service applications. This file is organized by month and the request for service is filed the month it is received in the DPA Division of Public Assistance office. In certain circumstances, the request for service application is pulled from the monthly file and filed either in the two, four or six-part folder. Follow the procedures below in determining when a request for service application is pulled from the monthly file:

1. Applicant completes the application process and a case file exists or is created

If an applicant completes the entire application packet and attends an interview, pull the applicant’s request for service from the monthly file. Match the request for service application with the completed application packet and file accordingly in the case file (existing or new). Refer to MS 103-1 for additional guidelines on organizing case files.

2. Applicant fails to complete the application process

If the applicant does not complete the entire application packet and fails to attend an interview, determine if there is an existing case file for the applicant.

If a case file exists, pull the request for service application and match it with the current case file. Place the document in the appropriate section. Refer to MS 103-1 for additional guidelines on organizing case files.

If there is no existing case file, leave the request for service in the monthly file created specifically for storing request for service applications.

103-2 E.     RETAINING AND DESTROYING REQUEST FOR SERVICE APPLICATIONS

Request for service monthly files will remain in the office for a three-year period. It is not necessary to archive request for service monthly files. After the three-year period is over, the files may be destroyed or shredded.