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Legal Forms Special Power of Attorney

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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-
                                                                           ins.
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
                                                                           Providers
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.




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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 10141).

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
                                                                   loan.
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

Income
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 16035).

Unearned Income                            R   N   UI              Child Support, alimony, Social Sec. Kinship Care.

Expenses
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 WAT.

W-2 Participation Agreement                R   Y   WPA             DWSW-10755 Wisconsin Works (W2) Participation Agreement
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)




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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.
Correspondence
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 NOD.

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) HCF
DDB                                                                     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.
DDB
Disability Determination Worksheet from       R     Y   DDWSH           This doc code is used by the DDB and is not to be used by IM workers.
DDB

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.




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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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Description: Legal Forms Special Power of Attorney document sample