Systems Operations
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ARIES Automated Requests
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Contacts
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

APA Application Change
Please provide the following (all fields must have a value)
Employee Info (Request Submitter)
Name:

Telephone #:

State Email:
Case Information
Change APA application from:

Is the client in the office?

Case Name: Case Number:
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?

Did you get the Bug more than once?

Did the Bug stop you from completing your EIS work?

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:
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?

   

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)
Case Note Deletion

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

Are you a Supervisor or Lead Worker?

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?



Case Note Deletion

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

Are you a Supervisor or Lead Worker?

Please provide the following:
Requester Info
Name:

Telephone #:

Email:

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

Case Note Title:

Case Note Date:   Case Note Time:

What is the reason for the deletion request?



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

Program Type:



Current Program Status:
Program End Date:

Program End Date:





Change Program Status to:





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

Program Type:



 
Current Program Start Date:

Correct Program Start Date:



Current Program End Date:

Correct Program End Date:


Member ID: 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:
Client Note Deletion

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

Are you a Supervisor or Lead Worker?

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?



Change Vendor ID
Please provide the following:
Requester Info
Name:

Telephone #:

Email:

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




Comments (Optional):
Application Deletion Request

The following are some situations when the program registration will not be deleted:
  1. A client requests a program and then decides not to pursue it.
  2. A client requested a program by mistake and is withdrawing the request after it has been registered in EIS.
  3. A client is determined to be ineligible for a program for any reason.
  4. An ATAP application is registered in EIS and we later find the application should have been forwarded to a Native TANF office.
  5. An application is registered but cannot be found in the office.
  6. A program is being converted to another (i.e. FM to DKC).
  7. An application is received from a client who is already receiving benefits.
  8. 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?
Please provide the following (all fields must have a value)
Employee Info (Request Submitter)
Name:

Telephone #:

State Email:
Application Details
Are you conducting an interview with this client?

Is this request preventing you from authorizing benefits for this client?

Case Name: Case Number:

Pick at least one Program Type and supply the Application Date:
Program TypeApplication Date


Program TypeApplication Date


Program TypeApplication Date



Program TypeApplication Date




Were any duplicate clients created with registration of this application?
Duplicate Client Info (To Locate Record)


Why must the application be deleted?






Application Deletion Request

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

Are you a Supervisor or Lead Worker?


The following are some situations when the program registration will not be deleted:
  1. A client requests PASS I, II, or III and then decides not to pursue it.
  2. A client is determined to be ineligible for PASS I, II or III for any reason.
  3. An application is registered but cannot be found in the office.
  4. The PASS type is being converted to another (i.e. PASS I to PASS II).
Have you read the above listed items?
Please provide the following:
Requester Info
Name:

Telephone #:

Email:

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





Program Type:




Are there PAID authorizations on the current application?

All UNPAID authorizations must be cancelled before the application can be deleted.
Are there any UNPAID authorizations?

Why must the application be deleted?







Were any duplicate clients created with registration of this application?
NOTE: Deleting an application does not delete duplicate clients that may have been created when the application was registered.

Provide Duplicate Client Info:


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



Application incorrectly registered as:



Change application to:



Are there PAID authorizations on the current application?

All UNPAID authorizations must be cancelled before changes are made.
Are there any UNPAID authorizations?

Comments (Optional):
Change Staff Member Information
Please provide the following:
Requester Info
Name:

Telephone #:

Email:

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




Change the following (provide details):
Remove Duplicate Staff Member
Please provide the following:
Requester Info
Name:

Telephone #:

Email:

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





Comments (optional):
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

Program Type:




Member ID:
Member First Name:  
Reason for member deletion:
 

Are there PAID authorizations on the current application?

All UNPAID authorizations must be cancelled before the application can be deleted.
Are there any UNPAID authorizations?
Member ID:
Member First Name:  
Wrong Relationship:  
Correct Relationship:  

Comments (Optional):
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:



Duplicate Client Information
Select One:


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.
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?


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?

Has the client viewed the warrant and verified that it is not their signature?

Has a police report been filed?

Has the Affidavit for Forgery (Gen 86) been completed, notarized, and signed by the client?
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.
General Question
Please provide the following (all fields must have a value)
Employee Info (Request Submitter)
Name:

Telephone #:

State Email:
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 not understood):
General System Question
Please provide the following:
Requester Info
Name:

Telephone #:

Email:

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

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)
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

Select One:















Comments (Optional):













Comments (Optional):
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



ISN:
Reason for deletion(s):
License #(s) from: to:
SSI Replacement
Please provide the following (all fields must have a value)
Employee Info (Request Submitter)
Name:

Telephone #:

State Email:
General Question Detail (please be as thorough as possible)
Case Name:

Case Number:

Benefit Month/Year to be Replaced:

Requested Amount:
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?
Do you have a signed Stop Payment Affidavit (GEN 21) on file?
Has it been at least 10 days since the warrant was issued?
Have you verified the ADDR screen information?
Is this a GA case?
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).
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?

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?
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
Warrant Copy Request
Please provide the following (all fields must have a value)
Employee Info (Request Submitter)
Name:

Telephone #:

State Email:

Fax Number:
Warrant Copy Detail
Client's Name:

Case Number:

Warrant Number:

Benefit Month:

NOTE: Only one month may be listed per Warrant Copy Request.
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)



Other Information - complete the box below