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MEDICAL SERVICES POLICY MANUAL,SECTION O O-200 Initial Requests for Medically Needy Services O 254 Completion of Application Forms

O-254 Completion of Application Forms MS Manual 01/01/14 The applicant or his authorized representative will complete and sign the application form. If disability is to be established, the DHS-4000, DCO-106, DCO-107 (or DCO-701) and DCO-108 will be completed for MRT (Re. MS F-120 section). For SSN enumeration procedures, refer to MS D- 400. At the conclusion of the interview, the applicant or representative will be given a DCO-002 to indicate the documents needed for the eligibility determination. At least 10 days will be given for return of the items needed, or longer if the applicant requests.

O-255 Registering the Application MS Manual 01/01/14 An application will be registered in ANSWER using the date it is received by the County Office. A register number will be system assigned to each application. The categories are: • 1M for Aged Individual-Exceptional and Aged Individual-SD • 2M for AFDC-Exceptional and AFDC-SD • 3M for Blind Individual-Exceptional and Blind Individual-SD 4M for Disabled Individual-Exceptional and Disabled Individual-SD • 5M for U-18-SD • 6M for Pregnant Woman-Exceptional and Pregnant Woman-SD • 7M for Unemployed Parent-Exceptional and Unemployed Parent SD • 8M for Refugee-Exceptional and Refugee-SD • 9M for Foster Care-Exceptional and Foster Care-SD Note: The Division of Children and Family Services (DCFS) Eligibility Unit will be responsible for completing and registering applications for Foster Care EC and Foster Care MN-SD.

O-256 Securing Information from Collateral Source MS Manual 01/01/14 Collateral information is evidence provided by persons other than the applicant or by written documents. Items requiring collateral evidence are designated in sections dealing with specific eligibility requirements.