Forms
Policy
TIERS
Resources
Income
100

What Form is used to verify a client's Authorized Representative

What is Form 1003?

100

This Chapter of the Handbook discusses Resources and the different types the client may have 

What is Chapter F?

100

What does the acronym LUW stand for?

What is Logical Unit of Work?

100

What is the resource limit for Nursing Facility cases for an individual

What is $2000?

100

What is this called when a client can divert their income to the community spouse

What is Spousal Diversion?

200

What Forms must be provided in order to send a client to the Disability Determination Unit

What is Form 3034 and 3035?

200

This section discusses how Incurred Medical Expenses are used when determining a client's copay

What is Section H-2000

200

This LUW can be used to update a client's SSN, Date of Birth, and trigger the Data Broker screen

What is Individual Information LUW?

200

This resource pertains to any property that they client currently has full or partial ownership of

What is Real Property

200

What is income received from wages/job considered?

What is Earned income?

300
This Form is sent in by the client and Authorized Rep to extend their due date for Nursing Facility Applications

What is Form 1215?

300

This Chapter in the handbook discusses Income and the different types a client may have 

What is Chapter E?

300

This interface is used to verify a client's gross SSI and RSDI along with their Part A and B

What is SOLQ?

300

This resource can be designated for burial to help qualify for benefits, but has a limit of $1500

What is Life Insurance?

300

What kind of income is RSDI and SSI considered 

What is Unearned Income?

400

This Form can be used to verify bank balances for client statement application, but not full verification 

What is Form 1239

400

This section of the handbook discusses Third Party Resources

What is D-7000?

400

This LUW is where we would enter if a client has a Qualified Income Trust

What is Trust Resources LUW?

400

This resource normally has a Primary or Secondary beneficiary

What is a Qualified Income Trust?

400

This unearned income type is usually provided from the client's employer during their retirement?

What is pension/retirement?

500

This Form is used to test a client for an Expanded SPRA

What is Form 1275

500

This chapter is where you would look regarding policy about Transfer of Assets

What is Chapter I

500

This question must be answered "yes" in order to input a client's Disability

What is "Client has a disability" question?

500

This procedure is used to count resources for the institutional spouse towards the community spouse for 1 full year to help qualify for Nursing Facility

What is a SPRA?

500

Income that is not consistent is considered this

What is Irregular?

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