PM 02-05-01
Clients give information for the screening portion of Form 2378C.
If AIS is not available or the applicant does not wish to give information for screening, issue Form 2378B
. Tell the applicant that help is available in completing the application form.
If someone other than the person requesting benefits comes in to complete the application, they must have a written statement from the applicant (see PM 02-04-02-a and WAG 02-04-02-a).
If the form is completed in the office, help the client if requested. If intake staff help complete the application form, write this on the application form.
An applicant may take the Form 2378B home and have relatives or friends help.
Complete Form 2378B for a home intake application when a person is physically unable to come to the Family Community Resource Center.
P3 TA Applications (City of Chicago)
The client's signature on the Authorization for Repayment of Interim Assistance (Form 2199), is an eligibility requirement for all P3 TA applicants.
The date the client signs Form 2199 is treated as the SSI application date if the client applies for SSI within 60 days of signing Form 2199. SSA calls this the "protective filing date".
SSA will not pay a client SSI benefits for a period earlier than the protective filing date, so this can result in increased benefits for a client.
(FCRC) So that a P3 TA client can have the earliest possible protective filing date, ask them to sign Form 2199 at the application screening interview.
(AIS) Automatically prints 2 copies of Form 2199 at the screening interview for an applicant who is not receiving SSI.
(FCRC) For mail-in screenings, request Form 2199 through the Forms Option (Option F) during the eligibility interview.
(System) Sends SSA a monthly data exchange tape of cases identified as active P3 TA cases with new SSI applications. This data exchange makes sure the client's retroactive SSI lump sum payment is sent to DHS.
(SSA) Uses the monthly data exchange tape as proof that Form 2199 was signed on the P3 TA application date.
(FCRC) Have the client sign both copies of Form 2199. Give one copy to the client and file the 2nd copy in the case record, available for SSA review.
