M E M O R A N D U M

IM-158  11/26/02  FORMS MANUAL REVISION #34:  IMU5 CODESHEET


SUBJECT:
FORMS MANUAL REVISION #34:  IMU5 CODESHEET
DISCUSSION:
The IMU5 Code Sheet has been revised.  It has been updated to include the following changes and additions:

Field 5 - CASE ACTION

  • 01 - Open Cash 
  • 05 - Reopen Cash
Field 7 - REASON FOR REJECTION OR CLOSING
  • 70 - Reached lifetime limit refused to cooperate 
  • 71 - Reached lifetime limit over income 
  • 72 - Reached lifetime limit over resources 
  • 73 - Reached lifetime limit not eligible for extension 
  • 74 - Other
  • 75 - Received within 12 months (PC only)
Field 13F - UNRELATED GUARDIAN
  • Separated the GAFP only codes under the heading GAFP ONLY
  • Removed codes N, O, P as Nutritional Assistance Program is now obsolete
Field 13G - LEVEL OF CARE 
  • A - GR, MA-GR, SAB, BP SP
  • $ - Temporary Assistance Cash
Field 13G2 - SANCTION REASON/REASON FOR T-XIX ONLY

TEMPORARY ASSISTANCE ONLY

Sanctioned and Included in Cash Grant

  • C - Refusal to cooperate with DCSE
  • F - Refusal to comply with work participation requirement
Sanctioned and NOT Included in Cash Grant
  • B - Refusal to cooperate with Vocational Rehabilitation
  • J - Received multiple benefits by misrepresenting identity
  • U - Drug Conviction
  • V - Fleeing Felon: probation/parole violator
  • N - Refusal to apply for or provide SSN
MAF ONLY SANCTIONS
  • C - Refusal to cooperate with DCSE
  • N - Refusal to apply for or provide SSN
THE FOLLOWING ARE FOR LOC "T" ONLY
  • T - Title XIX only; no sanction
  • L - BCCT Presumptive Eligibility
  • W - BCCT
  • S - Spenddown
  • H - HCB or MOCDD
  • P - PACE
  • O - 1619 AB
  • 1 - Basic Coverage Group-Premium
  • 2 - Basic Coverage Group-Non-Premium
  • 3 - Medically Improved Group-Premium
  • 4 - Medically Improved Group-Non-Premium
Field 13M1 - QMB/SLMB
  • N - No
  • Q - QMB
  • L - SLMB Level 1
  • 2 - SLMB Level 2
  • 3 - SLMB Level 3
  • W - QDWI
Field 13P1 - WORK REQUIREMENT CODES
  • H - Extension for Hardship
  • D - Mandatory Referred to DWD
  • W - Volunteer Referred to DWD
Field 13P2 - EXEMPTION/EXTENSION REASONS
  • 20 - Domestic Violence 
  • 21 - Substance Abuse 
  • 22 - Mental Health 
  • 23 - Team Conclusion 
  • 24 - Active in Children's Services and Income Maintenance 
  • 25 - Family Crisis
  • 26 - Pending Review
Field 23
  • T - Basic Coverage Group
  • I - Medically Improved Group
Field 27 - A (removed $10 min pay)

Field 42 - DOMESTIC VIOLENCE

  • Y - Yes
  • N - No
NECESSARY ACTION:
  • Review this memorandum with all appropriate staff.
DC/GZ
Distribution #6
(Code Sheet [pdf] available on Intranet only)

IM-157
[ 2002 Memorandums ]
 IM-159