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Title 5: Centrally Administered Programs Page 14 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Application Processing Revised July 3, 2009 Application Form Applications filed online via the hawk-i web site are considered signed electronically and the filing date is the day the form is received by the TPA. If an application was first filed with Medicaid and is subsequently referred to the hawk-i program by DHS, the date of application for hawk-i is the Medicaid application date. Withdrawal of Application Legal reference: 441 IAC 86.3(5) An application for hawk-i can be withdrawn at any time before the eligibility determination is made. The request for voluntary withdrawal of the application may be verbal or in writing. Do not require a reason or justification for the request. Do not encourage an applicant to withdraw an application. But, when appropriate, explain to an applicant the right to withdraw the application and the consequences of such action. Accept a verbal request for withdrawal only when it is certain that the person making the request is the parent or responsible person in the child’s household. If the requester’s identity is uncertain, ask the person making the request to confirm case information that only the parent or other adult in the child’s household should know, such as the parent’s own social security number, the social security number or birth date of the child, etc. Document the request for withdrawal and the reason for withdrawal if known. Issue a notice of decision indicating the application is being denied because the application was withdrawn. When an Application Is Not Required Legal reference: 441 IAC 86.3(6) Do not require an application for hawk-i when a child becomes ineligible for Medicaid. When this happens, the DHS worker makes a referral to the hawk-i program as part of the Medicaid automatic redetermination process. The Referral to the hawk-i Program, form 470-3565, or the automated hawk-i referral process are accepted in lieu of an application.