DPA SysOps Homepage

Agency/Contact	System(s)
EIS Help Desk	EIS, CMS, ICCIS, Document Direct
DPA EBT Help	Electronic benefits, direct deposits
DPA Claims	Claims for repayment of DPA cases
IT Help Desk	Desktop computer help
DPA Field Services	Field Services general mailbox
TPL Help Desk	Third Party Liability Help Desk (DHCS)
ASVS	Alien Verification System
DOL Help Desk	Department of Labor Help Desk

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Bug Report

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

Bug Information

Is the client in the office? Yes No

Did you get the Bug more than once? Yes No

Did the Bug stop you from completing your EIS work? Yes No

Case Name: Case Number:

Screen Before Bug: Screen Going To:

Benefit Month (MM/YY): Full Service Office #:

Description (What entries were you making? Which client?)

Paste Bug Screen here:

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Bug Report

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Bug Information

Did you get the Bug more than once? Yes No (Please try again)

Family Facility ID:

What screen were you on before the bug:

What screen were you going to when the bug appeared:

Description (What are you attempting to do?)

Paste Bug Screen here:
(Press Ctrl+V to paste. If prompted, “Allow access” to clipboard and press Ctrl+V again)

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Case Note Deletion

NOTE: Only Supervisors or Lead Workers are authorized to request Case Note Deletions.

Are you a Supervisor or Lead Worker?

Yes No (Cancel)

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

CC Email: (Optional)

Case Note Detail

Case Name: Case Number:

Case Note Title:

Case Note Date & Time:

What is the reason for the deletion request?

Added To The Wrong Case Number.
Text was deleted, need Title Bar removed.
Other reason (please describe the reason for the request).

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Case Note Deletion

NOTE: Only Supervisors or Lead Workers are authorized to request Case Note Deletions.

Are you a Supervisor or Lead Worker?

Yes No (Cancel)

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Case Note Detail

Family Facility ID:

Case Note Title:

Case Note Date: Case Note Time:

What is the reason for the deletion request?

Added To The Wrong Case Number.
Text was deleted, need Title Bar removed.
Other reason (please describe the reason for the request).

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Revert to Open or Change Program Status

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Program Detail

Family ID:

Program Type:

PASS I
PASS II
PASS III

Current Program Status:

Denied

Program End Date:

Closed

Program End Date:

Pended
Open
Other

Change Program Status to:

Open
Received
Pended
Previous Status

Comments (Optional):

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Correct Program/Participation Date

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Family Detail

Family ID:

Program Type:

PASS I
PASS II
PASS III

Correct Program Start and/or End Date Correct Participation Start and/or End Date(s) for member ID(s)

Current Program Start Date:

Correct Program Start Date:

Current Program End Date:

Correct Program End Date:

All members

Individual member(s)

Member ID: *Must be 10 digits	Member First Name:
CURRENT Start Date:	CORRECT Start Date:

CURRENT End Date:	CORRECT End Date:

CURRENT Start Date:	CORRECT Start Date:

CURRENT End Date:	CORRECT End Date:

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Client Note Deletion

NOTE: Only Supervisors or Lead Workers are authorized to request Client Note Deletions.

Are you a Supervisor or Lead Worker?

Yes No (Cancel)

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

CC Email: (Optional)

Client Note Detail

Client Name: Client Number:

Client Note Title:

Client Note Date & Time:

What is the reason for the deletion request?

Added to the Wrong Client Number.
Text was deleted, need Title Bar removed.
Other reason (please describe the reason for the request).

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Application Deletion Request

The following are some situations when the program registration will not be deleted:

A client requests a program and then decides not to pursue it.
A client requested a program by mistake and is withdrawing the request after it has been registered in EIS.
A client is determined to be ineligible for a program for any reason.
An ATAP application is registered in EIS and we later find the application should have been forwarded to a Native TANF office.
An application is registered but cannot be found in the office.
A program is being converted to another (i.e. FM to DKC).
An application is received from a client who is already receiving benefits.
Deleting an application does not delete duplicate clients that may have been created when the application was registered.

Have you read the above listed items? Yes No (Cancel)

Application Deletion Request

NOTE: Only Supervisors or Lead Workers are authorized to request Application Deletions.

Are you a Supervisor or Lead Worker?

Yes No (Cancel)

The following are some situations when the program registration will not be deleted:

A client requests PASS I, II, or III and then decides not to pursue it.
A client is determined to be ineligible for PASS I, II or III for any reason.
An application is registered but cannot be found in the office.
The PASS type is being converted to another (i.e. PASS I to PASS II).

Have you read the above listed items? Yes No (Cancel)

Change Program Type Request

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Program Type Details

Family ID:

Application Received Date:

Application incorrectly registered as:

PASS I
PASS II
PASS III

Change application to:

PASS I
PASS II
PASS III

Are there PAID authorizations on the current application? No Yes (Cancel)

All UNPAID authorizations must be cancelled before changes are made.
Are there any UNPAID authorizations? None or Already Cancelled Not Cancelled (Cancel)

Comments (Optional):

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Remove Duplicate Staff Member

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Facility ID:

Facility Name:

First Staff ID:

Staff Name:

Second Staff ID:

Comments (optional):

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Remove Incorrect Family Member or Correct Relationship

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Member Details

Family ID:

Program Type:

PASS New
PASS I
PASS II
PASS III

Remove Family Member(s) Correct Family Member Relationship(s)

Member ID: *Must be 10 digits
Member First Name: *Required
Reason for member deletion: *Required

Are there PAID authorizations on the current application? No Yes (Cancel)

All UNPAID authorizations must be cancelled before the application can be deleted.
Are there any UNPAID authorizations? None or Cancelled Not Cancelled (Cancel)

Member ID: *Must be 10 digits
Member First Name: *Required
Wrong Relationship: *Required
Correct Relationship: *Required

Comments (Optional):

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Duplicate Client Report

NOTES: DO NOT MAKE ANY CHANGES TO THE NAME, DOB, or SSN.

If the Client ID numbers are the same, this is not a duplicate but shows other names used by the client.

If the additional Client(s) are highlighted on the CLIS (Client Inquiry Short List) screen, the duplicate has already been reported to the Help Desk. This Client may be viewed for information but should not be used in registering a program.

If the CLPM (Client Profile/Maintenance) screen displays a highlighted edit, **DUPLICATE CLIENT... SEE CLIENT #06000xxxxx**, this is another indication the duplicate has already been reported to the Help Desk.

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

Select a response priority:

The client is waiting in the office.
Need response before 24 hours.
No urgency, can wait a few days.

Duplicate Client Information

Select One:

Looks like a duplicate, needs investigation.
Completed research, this is definitely a duplicate.

Find good client and duplicate client using CLIS. Cut and Paste client info from the CLIS screen below:

Explanation - Additional verified information i.e. spelling of first and last name, DOB, SSN, M or F, etc.

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EIS Change Suggestion

This form is used by Division of Public Assistance district office staff to submit requests to Field Services to fix or enhance the Eligibility Information System (EIS), including system-related problems, ideas for improvements, new notices, and revisions to current notices.

Upon submission this form will be sent to the DPA Field Services email address at dpafield@alaska.gov

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

Employee/Office Information (continued)

Position:

Office:

Region:

Suggestion Detail

Description: Provide a description of what is desired and explain the benefit.
Provide examples or other documentation.

Impact: Explain why this is requested and describe how it will improve case processing.
Explain how you are meeting the requirement currently.
When requesting a new notice, provide how often the notice might be used.

Frequency: How often do you encounter this issue?

Occasionally
Frequently
All the time

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Forgery Report

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

Basic Forgery Procedure

Do you have a copy of the forged warrant? Yes No

Has the client viewed the warrant and verified that it is not their signature? Yes No

Has a police report been filed? Yes

Has the Affidavit for Forgery (Gen 86) been completed, notarized, and signed by the client? Yes No

Forgery Detail

Client Name:

Case Number:

Warrant Number:

Benefit Month:

Only one Month per Forgery Report.

Mail original Affidavit for Forgery (Gen 86) to:

Systems Operations
Attention: Admin Assistant
3601 C Street, Suite 434
Anchorage, AK 99503

NOTE: A replacement warrant WILL NOT be processed until the
Original Gen 86 has been received by Systems Operations.

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General System Question

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Family Client/Member Facility Staff Other

ID:

General Question Detail (please be as thorough as possible)

Reason for Inquiry (subject matter):

Question & Detail (provide as much info as you can, try to be specific about what is needed):

Screen Shot (Optional):
(Press Ctrl+V to paste. If prompted, “Allow access” to clipboard and press Ctrl+V again)

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Duplicate Client/Member or Family ID Report

If the Client/Member ID numbers are the same, this is not a duplicate as other names or aliases used by the client will also display.

If the search function displays a Y in the duplicate field, it has already been identified as a duplicate. Duplicate client/member data may be viewed for information only and cannot be used to register a PASS program.

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

Duplicate Information

Duplicate Client/Member Information

Select One:

Looks like a duplicate, needs investigation.
Completed research, this is definitely a duplicate.

First client/member ID:

First Name and Last Initial:

Family ID if this client/member was previously registered:

Second client/member ID:

First Name and Last Initial:

Family ID if this client/member was previously registered:

Comments (Optional):

Duplicate Family Information

First family ID:

First Name and Last Initial of Parent 1 (P1):

Second family ID:

First Name and Last Initial of Parent 1 (P1):

Comments (Optional):

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Delete or Change License Number Request

Please provide the following:

Requester Info

Name:

Telephone #:

Email:

CC Emails (Use comma with no space to separate addresses).: (Optional)

License Detail

Facility ID:

Facility Name:

Delete License(s) Change License Number(s)

ISN:

Reason for deletion(s):

License #(s) from:

to:

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Stop Pay

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

Does the Issuance History show the Issuance Status (ISSU STAT) as Outstanding? Yes No
Do you have a signed Stop Payment Affidavit (GEN 21) on file? Yes No
Has it been at least 10 days since the warrant was issued? Yes No
Have you verified the ADDR screen information? Yes No
Is this a GA case? Yes No

Provide warrant address:

Street Address

Street Address (Continued - Optional)

City

State

Zip

Stop Pay Request Detail

Client's Name:

Case Number:

Warrant Number:

Benefit Month:

Reason for Request:

NOTE: Only One month may be listed per Stop Pay Request. (Reminder - Do Not send Gen 21 to Systems Operations).

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Time Limit Change Request

NOTE: A case note documenting the Help Desk request for a TLIP change must first exist on the case. If a note does not exist please complete the case note entry and then create this request.

Has a case note been added to the case?

Yes No (Cancel)

Please provide the following (all fields must have a value)

Is there a second adult on the case and does this request apply to all the 'Adults' in the case? Yes No

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

Time Limit Change Detail Client's Name:

Case Number:

Benefit Month (MM/YYYY):

Current 'Total Used' on TLIP:

New 'Total Used' Requested:

Reason for change, description

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Medicaid Review (MIRE) Deletion Request

Please provide the following (all fields must have a value)

Employee Info (Request Submitter)

Name:

Telephone #:

State Email:

Medicaid Review (MIRE) Deletion Detail

Case's Name: Case Number:

Why must the review be deleted? (select one; if no selection is made the request will NOT be sent)

The wrong case number was used (review belongs to a different case number)
We are going to reopen the program which was closed previously
We do not have an identifiable review (No legible name, no mailing address, or no signature)

Other Information - complete the box below

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