Page 5

4

himself and may or may not be the interviewee during the application interview, if applicable. Refer to Section 2005.05.10 which explains who may be interviewed, if required. The worker must inform the ICP that information about Rights and Responsibilities are included as an attachment to the Application. If an interview is required, please, refer to IHCPPM 2005.05.10. 1825.00.00 APPLICATION REGISTRATION PROCESS Application registration begins the application process for individuals requesting assistance. The purpose of application registration is to: • Gather basic demographic information on the individual(s) for application completion • Perform individual clearance, statewide clearance, prior contact checks and address inquiries through the Eligibility System • Initiate tracking of applications through the Eligibility System. 1825.05.00 COMPLETION OF THE APPLICATION The application process is initiated when either the Initial Contact Person (ICP) requests assistance from the DFR to complete the Indiana Application for Health Coverage or actually submits a complete Indiana Application for Health Coverage with the DFR through the FSSA Benefits Portal (https://www.ifcem.com/CitizenPortal/application.do). The ICP must be given an opportunity to review the information that was recorded and must be given a copy of the information. This application is then signed by the ICP. The application can be printed in either English or Spanish. The ICP may also elect to take a printed application form from the FSSA Benefits Portal to complete outside the office or the form may be mailed to an individual or family identified by the ICP by having the application printed through the FSSA Benefits Portal. The ICP should be advised that the completed application should be mailed to the FSSA Document Center, brought to the DFR, or faxed to 1-888-436-9199. An Indiana Application for Health Coverage is considered valid when, at minimum, a name, address, and signature are provided. Individuals without a fixed address (homeless) may use the address of the DFR when applying, if the individual has no other reliable address where she can receive mail. Once the application has been signed, the recorded information supplied by the ICP is not to be changed nor is information to be added. The date of application is the date on which a signed application is received by the DFR.