Page 500

DHS Form 886-W: Notification of District Ward Status

This is to advise you that the following child(ren) are now considered to be District wards. Accordingly, they have been coded out of a former AR/AX Medicaid cases. They have NOT been coded out of their former TANF and Food Stamps households. Please take appropriate case actions and send a timely notice to the TANF/Food Stamp head-of-household. Also, please work to resolve matters related to any TANF overpayments or Food Stamp over- issuances.

Child's Last Name Child's First Name SSN Date of Birth TANF/FS Case Number(s)

Comments/Notes:

SSR – Medicaid Branch

Tel: (202)

Fax: (202) 724-8963 Income Maintenance Administration Department of Human Services Government of the District of Columbia Carbon Copy to: Maude Holt Chief, Managed Care Medical Assistance Administration (202) 442-9074 tel (202) 442-4790 fax

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Page 500

Official source

DHS Form 886-W: Notification of District Ward Status

This is to advise you that the following child(ren) are now considered to be District wards. Accordingly, they have been coded out of a former AR/AX Medicaid cases. They have NOT been coded out of their former TANF and Food Stamps households. Please take appropriate case actions and send a timely notice to the TANF/Food Stamp head-of-household. Also, please work to resolve matters related to any TANF overpayments or Food Stamp over- issuances.

Child's Last Name Child's First Name SSN Date of Birth TANF/FS Case Number(s)

Comments/Notes:

SSR – Medicaid Branch

Tel: (202)

Fax: (202) 724-8963 Income Maintenance Administration Department of Human Services Government of the District of Columbia Carbon Copy to: Maude Holt Chief, Managed Care Medical Assistance Administration (202) 442-9074 tel (202) 442-4790 fax