ADMINISTRATIVE PROCEDURES MANUAL

 

 

ADDENDUM 109 B

REPORT OF CHANGE CANO TEMPLATE

AND REPORT OF CHANGE GUIDE

 

 

Report of Change CANO Template:

 

SUBJECT

ELEMENTS

RECORD TITLE

  • Enter: “ROC, type of change and action”

 

    For example:

    ROC – Job Ended – Case Pended

 

  • If multiple changes are reported, caseworkers have the option of using acronyms

  

    For example:

    ROC – ADDR/EAIN/DEMH – Benefits Changed

 

 

DATE RECEIVED/SOURCE OF REPORT:

  • Document the date the report was received, how it was received, and who reported the change.

CHANGE REPORTED

  • Document change reported.

 

Note: Refer to “Change Report Guide” for pertinent information to ask when accepting reports of change by phone or face-to-face.

 

  • State if report of change was routed to another worker (ET, WDS, case manager, service provider) or agency

 

  • Document action taken based on report of change.

 

  • It is highly recommended and preferred to document notices that were sent, but it is not required.

 

 

 

 

Change Report Guide


CHANGE REPORTED

QUESTIONS TO ASK / INFORMATION NEEDED

 

CHANGE IN EMPLOYMENT    
(INCLUDING SELF-EMPLOYMENT)

 

 

 

   Did the household member start or end a job?

 

  • If the household member started a job, document the following information:

  • Employer’s/supervisor’s name and telephone number

  • Start date of employment

  • Expected hours of work per month or work schedule

  • Full-time or part-time

  • Hourly pay rate

  • Pay period

  • Verification used; if collateral contact was used, list the name and telephone number

 

   If the household member ended their job:

  • Employer’s/supervisor’s name and telephone number

  • Date of job ending

  • Reason for job ending

  • Date and amount of last pay received including YTD gross

  • Verification used; if collateral contact was used, list the name and telephone number

 

   If the household member changed employment status from full-time to part-time:

  • Effective date of change

  • Hours of work and schedule

  • Hourly pay rate

  • Full-time or part-time

  • Verification used; if collateral contact was used, list the name and telephone number

 

   Change in self-employment

  • Effective date of change

  • Type of self-employment

  • Period of self-employment

  • Monthly gross earnings

  • Seasonal or annual

  • Income and expenses allowed (50% versus actuals)

  • Verification used; if collateral contact was used, list the name and telephone number

 

 

CHANGE IN ADDRESS

 

 

 

   *** not applicable for SNAP Semi-Annual Reporting

 

  • New address

  • Household composition ***

  • Date of move

  • Monthly rent amount / mortgage payment/subsidized housing

  • SUD / Anticipated utility payments ***

  • Type of verification ***         

 

 

CHANGE IN HOUSEHOLD COMPOSITION

 

 

  • Name of the person who moved in or out of the home

  • Date the person moved in or out

  • Relationship of the PI to the person

  • Social security number

  • Date of birth

  • Income

  • Resource

  • Purchase and prepare (for SNAP)

  • Verification used; if collateral contact was used, list the name and telephone number

  • Apply appropriate program rules for other information needed.

 

BANK ACCOUNT OR CASH ON HAND EXCEEDS $2000

 

 

  • Name of bank or institution

  • Account number

  • Source of money deposited in the bank or cash on hand

  • Verification used; if collateral contact was used, list the name and telephone number

 

 

 GETTING A VEHICLE

 

 

  • Make, model, year of vehicle

  • Value of vehicle

  • Amount owed

  • How is this vehicle used? (i.e., family/basic transportation, going to work, etc.)

  • Verification used; if collateral contact was used, list the name and telephone number

 

 

 

CHANGE IN SOURCE OF UNEARNED INCOME OR CHANGE IN TOTAL UNEARNED INCOME OF MORE THAN $50

 

 

  • Source of income

  • Amount of income

  • Effective date of change

  • How long is the change anticipated to last

  • Verification used; if collateral contact was used, list the name and telephone number

 

 

CHANGE IN THE AMOUNT OF THEIR LEGALLY OBLIGATED CHILD SUPPORT:

 

  • New amount

  • Effective Date of Change

  • Verification used; if collateral contact was used, list the name and telephone number

 

 

CHANGE IN MEDICAL INSURANCE COVERAGE

 

  • Primary holder

  • Insurance company’s name, address and telephone number

  • Effective date of coverage for each person covered

  • Name of household members covered

  • Extent of coverage (i.e. medical, dental, vision, accidental only, etc.)

  • Group and policy number

  • Verification used; if collateral contact was used, list the name and telephone number

 

 OTHER CHANGES

 

 

* The client may report other changes that are not addressed above. These may include a change in their work hours, change in current    shelter costs or the purchase of property. These reported changes must be documented. The caseworker is responsible for redetermining eligibility and benefit amount based on the change reported. Inquire about any retirement resources or income.

 

 

 

 

 

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2012-01 (05/12)