Full Intake Form Financial Information

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1 1. Financial Information A. Number in Household a. Enter the Number of People 18 and Over b. Enter the Number of People Under Household Income B C D E A F G A applicant name (will already be filled out) B Income Source click on arrow next to field to select Income Source C Select how often the applicant is paid the amount from Income Source D This field will autopopulate (LegalServer automatically complete it) w/ # of payments based on Frequency selected E Enter the amount of the payment F Click on the icon w/ red to delete an income source G Click on the icon w/ green to add another income source NOTE! If there was an additional household member (added as a non-adverse party), you determined you need to include their income - their name appears in dropdown where applicant s name is also listed (see A above). Select their name and add an income if their income needs to be included. Different example than above - click on the green icon (G above) to both add additional income for the applicant, and/or to add another person s income, select that household member from the drop down, enter their income source, etc. (follow B-G above again to complete).

2 A. Applicant name will already be completed for this field. B. Select the type of Income from the drop down C. Enter the frequency of payments received by the applicant (there are more options than in Kemps, just choose what works for the applicant). Here biweekly has been selected.

3 D. Number of payments will auto populate based on response to Frequency question. E. Enter the income amount for that specific income type F. & G. Choose the icon w/ the red to delete an income source, or the icon with the green to add another income source. 3. LegalServer auto calculates the percentage of poverty based on any income reported and household size. 4. Income Changing? a. Response is No, proceed to next question. b. Response is Yes, complete the next question explaining why they think their income might be changing. Note! When you see the two small lines on the end of any text box, you can click on the lines, hold down your mouse and expand the size of the text box if needed!

4 5. Income eligible? a. If clearly yes, proceed through the interview. i. If the percentage of poverty is less than 125%, a green Yes appears in the Income Eligible section. No Override is needed. b. If can Override, and need to complete a Financial Exception form, follow the instructions at B Income and Asset Override Approvals c. If not income eligible, explain why in the Financial Notes close to the bottom of that page, and click on Save & Continue to save the data. 6. Asset Information Tip! Look for yellow to see additional instructions (like this!) throughout the interview. a. Answer Yes or No to the question Is this Needs based Public Assistance?

5 b. Ask the applicant whether they have each time of asset (you must ask about each one). c. Enter the amount (if applicable) to the right of each asset type. d. Type 0 (zero) in the asset amount field if the applicant does not have that type of asset. a. Do not type NA in the asset fields you will get an error message! e. If necessary, type in any notes to the right of each asset field. c. & d. - MUST enter amount for each b. e. f. Note how the Total up above the first asset changes as you add each asset amount. g. If, for some reason, you need to add more assets, click on this icon, bottom right of the assets, to add additional assets.

6 h. If the applicant is asset eligible, you will see the green Yes (see below). i. If you think that there is an asset Override, click on Override and follow the instructions in B. NOTE! Jon Asher has to approve all asset Overrides see instructions for more details. j. Put any Notes regarding Household members or the Financial Information here. k. Click on Save & Continue (burn that into your memory, please)! Remember! If you want to get wordy about your Notes, click on the bottom right and expand your Notes text box.

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