Authorized Guardianship Forms by upo13181


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									                                                                                                                                                      File Folder Contents "Beginner"

Sub-Folder / Document Type              Scanning PIN/SSN Document      Description / Special Instructions
                                        Required Specific Naming
                                        / Optional        Convention

Case Information
Applications (Non-CAF)                     R         N    APP          Scan any RFAs or Applications. Includes the HCF16019A and its translations.
                                                                       Previously RFAs used the RFA code. Do not use the RFA Doc code anymore. If
                                                                       it's a mail-in CAF, or the client brought a completed CAF to the office, scan the
                                                                       whole thing, excluding instructions. Include Combined Application forms, blue fold-
                                                                       outs, white mail-ins. .

                                                                       CARES generated ACCESS applications (Apply For Benefits) are automatically
                                                                       stored in the ECF with the APP code. Include RFAs and applications for
                                                                       Medicaid, FoodShare, W-2 and Related Programs Application (DWSW-2471), W-
                                                                       2 and Related Programs Registration (DWSP-14880), Child Care, Emergency
                                                                       Assistance Application (DWSW-2010), Job Access Loan Application (DWSP-
                                                                       2482), refugee application paper work and applications for other programs such
                                                                       as W-2 emergency payments, county issued programs, HCF 10081, HCF 10119,
                                                                       HCF 16060, HCF 16019, HCF 10112, HCF 10138, HCF 10129, HCF 10076, HCF
                                                                       10100, HCF 10101, HCF 10140, FSET Non-cooperation form letters asking the
                                                                       FoodShare be reinstated, Wisconsin Veterans Home at King - Medicaid Review
                                                                       (HCF 10147).
Authorization of Representative forms      R         N    REP          W-2 and Related Programs Authorization of Participant Representative form
                                                                       (DWSP-2375), the Authorized Representative section of ACCESS' Apply For
                                                                       Benefits, if completed.

CARES Application Forms                    R         N    CAF          Scan signature page only. Combined Application forms, blue fold-outs, white mail-
Change Reporting Form                      R         N    CHG          HCF 16006 (FoodShare Wisconsin Change Report), HCF 10137 (Medicaid
                                                                       Change Report), HCF 16066 (FoodShare Wisconsin Income Change Report),
                                                                       DWSP-2001 (Change Report), ACCESS Report My Changes Change Reports
                                                                       are stored in the ECF with the CHG code.
Child Care Worksheet                       R         N    CCWS         All CC related worksheets, including manual Child Care payment worksheets,
                                                                       DES-11559 Child Care Payment Worksheet for edited Licensed Child Care
                                                                       Providers,DES-11560 Child Care Payment Worksheet for Certified and Accredited
                                                                       Certified Child Care Providers, DES-11561 Child Care Payment Worksheet for
                                                                       Attendance Based Payments to Licensed Child Care Providers, DES-11562 Child
                                                                       Care Payment Worksheet for Enrollment Based Payments to Licensed Child Care
Complete Case File                         O         N    CCF          This code can be used on a case cover sheet to indicate that it is a complete
                                                                       case file. This code is intended to be used in Milwaukee County, but can be used
                                                                       in other locations, as appropriate. For more information, please contact us by
                                                                       sending a note to "Contact Us" above.
Electronic Benefit Transfer                R         N    EBT          EBT related documentation.
Fair Hearing Requests and Decisions        R         N    FH           DHA-28 and other written requests for a fair hearing.
Over-payment/Recoupment                    R         Y    OP           Overpayments, underpayment and benefit recovery documents used for over
                                                                       payment or under payment calculation., AFDC and/or W-2 Services Repayment
                                                                       Agreement DES-10790 Wisconsin Works (W2), Overpayment Recoupment
                                                                       Notice, Food Stamp Financial Worksheet (HCF 16073) and FoodShare
                                                                       Wisconsin Worksheet (HCF 16033)

                                                                       (DES-10787) Wisconsin Works (W2) Overpayment Worksheet (DES- 10785),
                                                                       BV worksheets, associated letters. Sheriff's reports and manual wage verification
                                                                       used to calculate overpayments. Request for Write Off or Adjustment DWSD-
                                                                       11439. State Letter of 'Acknowledgment of Receipt'. For overpayments related to
                                                                       fraud, refer to FRAUD.
Request for Assistance                     R         N    RFA          This code is obsolete. Code any requests for assistance or applications with the
                                                                       "APP" code.

SMRF Form                                  R         N    SMRF         FoodShare Six Month Report Form. HCF 16076
Requesting Verification                    R         N    VER          Includes all non-CARES generated request for verification documents including
                                                                       checklists, agency letters, Request for Verification form (DWSP-2303), etc.

Non Financial Information
Declining Aid forms                        O         N    DAF          Voluntarily Declining Aid (DWSW-2233)
EVF-H form                                 R         Y    EVFH         Centrally scanned. If the client turned in the form at your agency, you may scan
                                                                       it and act on the change.

Internal or State QC Info                  O         N    QC           FoodShare TCRs, other Quality Control or Quality Assurance documents.
Legal Documents                            R         Y    LEGAL        Includes guardianship papers, power of attorney, divorce, separation, Marriage
                                                                       certificates. Bankruptcy papers. Notice of Intent to File a Lien, MA-113.
                                                                       Affadavits of Lost, Destroyed, or Stolen Benefits (FIS-12768). For all Child
                                                                       Support legal documents, refer to CS.
Proff of Identity                          R         Y    ID           Any identity or citizenship document or form: Includes birth certificate, baptismal
                                                                       certificate, immigration status docs, drivers license, passport, state id's, county
                                                                       ids. Do not scan birth queries or birth notification letters from the state. P-140.
                                                                       Also, any documents used to meet the MA/BC citizenship and identity verification
                                                                       requirement. Includes the forms: Statement of Identity for Children Under 16
                                                                       Years of Age (F-10154), the Spanish version of this form (F-10154S),( Assign
                                                                       these to the primary person) and Statement of Citizenship and/or Identity for
                                                                       Special Populations (F-10161). See DC for Death Certificates.

Sanctions                                  O         N    SANC         Documents related to sanctions (excluding W-2 hour sanctions or strikes).
                                                                       Includes FoodShare, FSET sanctions, approved or denied and sanction cures,
                                                                       drug felony, and all IPV documents, including W-2. For W-2 hourly sanction and
                                                                       strike documents, refer to WSGC.
School Information                         R         Y    SCHL         School related documents used for all programs except Learnfare. For Learnfare,
                                                                       refer to WLCM. Includes school schedules used for Child Care authorizations,
                                                                       Financial Aid Information, Student Financial Aid Report (HCF 16021).
Separate Eating forms                      O         N    SEF          Household information request
Social Security Card                       O         Y    SSN          Not considered proof of identity. Only scan cards where the number has not yet
                                                                       been validated or has a mismatch on CARES. Application for a SSN, HCF 16022
                                                                       Social Security Number Referral
Miscellaneous Nonfinancial                 R         Y    MNF          Use this document code for any nonfinancial document that doesn’t have a
                                                                       specific code. Examples are the HCF 10186 "Designation of a BadgerCare Plus
                                                                       Essential Person, Funeral and Cemetary Aids Reimbursement Request (HCF
Spousal Allocation Statement               O         Y    SAS

Asset Information
All Funeral/Burial Related Info            R         N    FB           Primarily related to funeral or burial assets.

Annuity Contracts                          R         N    ANNC
Asset Information - Other                  R         N    AST          Life Estate legal documents, land contracts, trusts, Tax Bill, Assessment, property
                                                                       values, property sales listing, etc. Retirement account information. Home equity
Bank Accounts                              R         N    BNK          Checking, savings, certificates of deposit (CDs). Bank Inquiry
Life Insurance Policies                    R         N    LIP          No need to copy full policy that can be obtained from Insurance Agent. Term,
                                                                       group, or whole (face and cash value). Life Insurance Information request, Life
                                                                       Insurance Inquiry (HCF 10144).
Stocks and Bonds Info                      R         N    SB           Savings Bonds.
Vehicle Info                               R         N    VI

Earned Income                              R         Y    EI           Paychecks, check stubs, paystubs, etc. (treat as a multi-page document if more
                                                                       than one per job), employer statements.
EVF-E form                                 R         Y    EVFE         Centrally scanned
Self-employment Income                     R         Y    SEI          Includes SEIRF's, other self employment info, tax forms for the most current tax
                                                                       year, and Self-Employment Income Report (DWSP-2131), room and board
                                                                       documents/ forms, Self Employment Income Worksheet - Corporation (HCF
                                                                       16034), Self Employment Income Worksheet – Partnership (HCF 16036), Self
                                                                       Employment Income Worksheet – Sole Proprietor Farm and Other Business (HCF
                                                                       16037), Self Employment Income Worksheet – Subchapter S Corporation (HCF
Unearned Income                            R         N    UI           Child Support, alimony, Social Sec. Kinship Care.

Child Care Expense                         R         N    CCE          Child Care receipt Manual Child Care Authorization Sheets
Child Support Expense                      R         N    CSE          All Child Support expense related documents, including documents related to
                                                                       child support payments.
Residency and Shelter/Utility Expense      R         N    SUE          The most current lease (even if expired), shelter forms , proof of rent, utility bills
                                                                       such as phone or electric, tax payments, mortgage, property taxes, Section 8
                                                                       papers, CDA papers, homeless agreements, etc. In / Out of Nursing Home form

W-2 / FSET
Electronic Funds Transfer                  R         Y    WEFT         Electronic Funds Transfer Authorization (DES- 10791)
Fact Finding documents                     R         Y    WFF          Wisconsin (W-2) Agency Fact finding Review Notice (DES-10782), Request for
                                                                       Wisconsin Works (W-2) Fact Finding Review (DWSW-10783) , Wisconsin Works
                                                                       (W-2) Agency Fact Finding Review (DWSW-10784), W-2 Services Fact Finding
                                                                       Review Voluntary Withdrawal (DWSW-11155)
Household Budget Worksheet for W-2         O         N    WBW           Household Budget Worksheet for W-2 (DES-2443)
Learnfare Case Management Plan             R         Y    WLCM         Learnfare release and other school enrollment and attendance information DES-
                                                                       10789 Learnfare Case Management Plan
Miscellaneous Work Program documents       O         Y    WMSC         For all other work program documents in which an appropriate document type
                                                                       does not exist
Out of State Inquiry                       R         Y    WOSI         Information about benefits received in other states - Out of State Inquiry (W-2)
                                                                       form (DES-4021)
Vendor Payment Request                     R         Y    WVPR         DES-3147 Vendor Payment Request.
W-2 Attendance Tracking                    R         Y    WAT          The log of training activities and job search preparation activities
W-2 Barrier Screening Tool Documents       R         Y    WBST         All Barrier Screening Tool (BST) documents including the BST Agreement form
                                                                       (DWSW-13578). Do not scan a paper copy of the tool unless the tool is not
                                                                       entered into the BST system.
W-2 Job Search Log                         R         Y    WJSL         Include all job search log documents and any documentation used to verify
                                                                       contact with employers, e.g., copies of business cards, employer letters, etc..
                                                                       For all other attendance tracking, including facilitated job search activities, refer to
W-2 Participation Agreement                R         Y    WPA          DWSW-10755 Wisconsin Works (W2) Participation Agreement

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                                                                                                                                           File Folder Contents "Beginner"

W-2 Placement-Related Forms                   R     Y   WPF     All W-2 placement related forms, including (e.g., Trial Job Employer Agreement
                                                                (DES-10759), W-2 Worksite Training Site Agreement (DES-10792), W-2 Case
                                                                Management Services Agreement (DWSP-13269), worksite evaluations and
                                                                participant's progress reports. For worksite attendance or any other attendance
                                                                documents, refer to WAT.
W-2 Supportive Services Plan                  R     Y   WSSP    Supportive Services Plan (DWSW-12956-E)
W-2/FSET Employability Plan                   R     Y   WEP     This includes the signature page of the CARES printed EP, any paper EPs not
                                                                contained in CARES, Wisconsin Works (W-2) Employability Plan (DES-10788)
                                                                and any other supporting documentation used to supplement the information
                                                                contained in the EP.

Miscellaneous / County Specific

Child Care Miscellaneous                      R     N   CCMSC   Any other Child Care related document not otherwise specified.
Other County Documents                        O     N   OCNTY   Includes county generated documents or forms that do not fit into another
                                                                category. Does not include documents generated by the customer or State
                                                                forms. All SeniorCare forms.
Uncategorized Correspondence                  O     N   UCOR    Includes Letters to other Agencies. Envelopes from mail that has been returned to
                                                                the agency. Notes from the customer, including notices with changes. EOS forms
                                                                send to other state to check for open benefits. Call Center E-mail
                                                                correspondence, emails from customers reporting changes, etc.
Application Notice for Pregnant Women         N/A   N   APNPW   These documents are not scanned. They are converted to PDFs by CARES and
                                                                stored with this document code.
Application Notice for Children               N/A   N   APNCH   These documents are not scanned. They are converted to PDFs by CARES and
                                                                stored with this document code.
Application Summary for Pregnant Women        N/A   N   APSPW   These documents are not scanned. They are converted to PDFs by CARES and
                                                                stored with this document code.
Application Summary for Children              N/A   N   APSCH   These documents are not scanned. They are converted to PDFs by CARES and
                                                                stored with this document code.
Correspondence                                N/A   N   CORR    These documents are not scanned. They are converted to PDFs by CARES and
                                                                stored with this document code. CORR is used for all other miscellaneous
                                                                CARES generated notices and letters. For manual notices an agency sends, see
Notice of Decision                            R     N   NOD     Non-CARES generated Notices of decsion including the Medicaid Recipient Asset
                                                                Allocation Notice (HCF 10098), Community Spouse Asset Share Notice (HCF
                                                                10096), Medicaid Recipient Asset Allocation Notice (HCF 10097), Medicaid
                                                                Recipient Income Allocation Notice (HCF 10098), Funeral and Cemetery Aids
                                                                Program Reimbursement Notice (HCF 10143).

Disability Determination Bureau
(DDB) (Restricted)
DDB Related Information                       R     Y   DDB     DDB Packet (the red folder contents). You must scan the contents of any red
                                                                folder you have in your agency. Use the DDB code for the contents of the red
                                                                folder and any miscellaneous DDB document that is not specifically covered by
                                                                the new codes. Use DDB for manual DDB decision letters. Red folders were
                                                                made obsolete after the automation of DDB processing in October 2007. New,
                                                                more specific document codes were added in October 2007 for other types of
                                                                DDB documents. See ADDD, MADA, ADDMD, DDDOC, and DDWSH for details.

MADA Application                              R     Y   MADA    Medicaid - Disability Application HCF 10112
Authorization to Disclose Information for     R     Y   ADDD    Authorization to Disclose Information to Disability Determination Bureau (DDB)
DDB                                                             HCF 14014
Additional Disability Determination Medical   R     Y   ADDMD
Documents for DDB
Disability Determination Documents from       R     Y   DDDOC   This doc code is used by the DDB and is not to be used by IM workers.
Disability Determination Worksheet from       R     Y   DDWSH   This doc code is used by the DDB and is not to be used by IM workers.

Restricted Documents
Child Support                                 R     N   CS      All Child Support (non-expense related documents) including initial or subsequent
                                                                paternity orders, court orders regarding support payments, referrals to child
                                                                support, including Good Cause Claim (DWSP-2019), Good Cause Notice (DWSP-
                                                                2018), Notice of Assignment- Child Support, Family Support, Maintenance and
                                                                Medical Support (DWSP-2477), Any legal documents regarding Child Support
                                                                should use the CS code and not LEGAL. For specific CS expenses, use CSE.

CIP/COP Info                                  R     Y   CIP     COP Assessment, CIP/COP Approval Letters, Waiver Requests. Family Care
                                                                (pilot program) documents, Interagency Notification of Termination of Medicaid
                                                                Waiver Eligibility For a Community Waiver Participant (F-10142), Unprocessed
                                                                Family Care, Pace, or Partnership Disenrollment Request (F-00009)

Child Welfare                                 R     Y   CW      Any child welfare related documents including the HCF 10184 Badgercare Plus
                                                                Youth Exiting out of Home Care and 10185 BadgerCare Plus Child Welfare
                                                                Parent/ Caretaker Relative Communication.
Death Certificates                            R     Y   DC
Documentation Referral to Other Agency        R     Y   WDR     This is used for referrals to outside agencies such as the DVR and CAP
                                                                programs, assessment referral forms, etc. This includes work program referrals,
                                                                supportive services referrals, etc. For referrals within an agency, refer to OCNTY.

Estate Recovery Prog. Disclosure forms        R     N   ERPD
Fraud Related Information                     R     N   FRAUD   All documents supporting fraud claims, minus copies that can be obtained from
                                                                CARES, Fraud and Front End referral forms. Supporting documents for
                                                                overpayments related to fraud. For all other overpayments, refer to OP. For IPV
                                                                related documents, refer to SANC.
MA Manual Eligibility Forms                   R     N   MAEF    MA Remaining Deductible Form (HCF 10109), MA Cert Form (3070) in order of
                                                                initial date of certification, and spousal impoverishment allocation forms.
                                                                Authorization for Retroactive CTS Emergency MA paperwork. Wisconsin Well
                                                                Woman Medicaid Determination, Good Faith Medicaid/BadgerCare Plus
                                                                Certification (HCF 10111).
Medical Assessments                           R     Y   MAS     Drug test results and all documents formerly coded as MDE (Physician's
                                                                Evaluation): Mental health or other incapacitation docs, special needs documents
                                                                (child care), pregnancy verification. Drug Test Results, Temporary Stay for
                                                                Nursing Home, Medicaid Purchase Plan (MAPP) - Work Requirement Exemption
                                                                (HCF-10127). See DC for Death Certificates.
Medical Exam and Capacity Form (W-2)          R     Y   WME     W-2 Medical Exam and Capacity Form (DES-2012). For all other physician's
                                                                evaluations or medical assessments, refer to MAS.
Medical Expenses/Deductible Documents         O     N   ME      Cover sheet and all verifications of medical costs, other health insurance,
                                                                pharmacy and doctor bills. Copies of checks for BadgerCare premiums and
                                                                payment coupons, Medicaid Purchase Plan (MAPP) Member / Premium
                                                                Information (HCF-10122).
Non-Medical Assessments                       R     Y   WVAS    All non-medical assessment documentation, including vocational assessments,
                                                                career/employment readiness assessments, education assessments, AODA
                                                                assessments, domestic violence assessments, self-declared needs assessments,
                                                                family profiles, etc.
Release of information forms                  R     Y   ROI     Any release of information form, including Authorization for Disclosure of
                                                                Confidential Information (DWDS-10779) form, School Enrollment and Attendance
                                                                Information Release (DES-11297). Documents that used to be coded as CONF
                                                                should now use the ROI code.
Sanction and Good Cause documentation         R     Y   WSGC    For all W-2 nonparticipation or noncooperation related documents, including
                                                                hourly nonparticipation, nonparticipation strikes and good cause documents. For
                                                                IPV related docs, refer to SANC.
SSI/SSDI Referral/Advocacy documents          R     Y   SSIA
TPL / Accident Report                         O     N   TPL

W-2 Attendance Tracking                       R     Y   WAT     Include individual timesheets, group sign-in sheets, computer printouts or other
                                                                documentation verifying attendance at a W-2 activity, including education and
                                                                training attendance documentation and facilitated job search activity tracking. For
                                                                independent job search logs, refer to WJSL. For other documents related to
                                                                school, refer to SCHL.
W-2 Agency Extension Record                   R     Y   WEX     DWSW-11661-E W-2 Agency Time Limit Extension Record.
W-2 Service Provider Correspondence           R     Y   WSPC    Documents to service providers outside of the W-2 agency that are confidential.
                                                                For non-confidential documents to service providers, refer to UCOR.

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