WAG 25-07-08-a: AABD, GA, and TANF Cases

To authorize supplemental mercury benefits, complete a blank Form 552 as follows:

• Item 1 - Complete.
• Item 2 - Enter the month and year (4 digits) that the increase was effective.
• Item 3 - Enter TA 31.
• Item 4 - Enter 2.
• Items 5, 6 - Complete.
• Items 8-10 - Enter the name and address as it currently exists in the Client Database.
  • NOTE: If the name or address has recently changed, the change must be made on the regular roll before the mercury request is authorized to the new name or address.
• Item 38 - Enter the total amount of supplemental benefits for the month entered in Item 2.
• Item 80 - Complete. The total of amounts entered in Item 80 must equal the amount entered in Item 38.