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If a request is made over the phone the call will be recorded for future reference, and a case note should be made that a withdrawal request was made over the phone with relevant details. A separate written request is not required.

If a request to withdraw from assistance is made verbally in person, a signed statement should be added to the case file.

For verbal voluntary withdrawals, eligibility should be discontinued based on the member’s request without requiring separate written confirmation.

Please note that discontinuance due to voluntary withdrawal should be effective the end of the month in which the request is made.

1 42 CFR 431.231(d) 2 42 CFR 431.213 3 IC 12-15-1-20.4(a) 4 IC 31-37-22-9 5 IC 12-15-1-20.4(b) 6 IC 12-15-1-20.4 7 42 CFR 435.926(c)(2) 8 1902(e)(3) of the Act and 42 CFR 435.225