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Is Life Insurance Required in a Divorce Agreement document sample
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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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File Folder Contents "Beginner"
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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File Folder Contents "Beginner"
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)
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.
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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File Folder Contents "Beginner"
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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