ACCESS Florida Web Application Guide October 2011 1
ACCESS Web Application Process Flow... 5 ACCESS Florida Splash Page... 9 Welcome What Would You Like to do?... 10 Benefit Choices... 12 Drug Testing Information Acknowledgement and Consent Release... 14 Relative Caregiver Eligibility Requirements... 15 Medicaid... 16 Important Information... 17 ACCESS Online User Sign-Up... 19 Applicant Information... 20 Address Validation... 21 Application Summary... 22 Household List... 23 Rights and Responsibilities... 25 HIPAA... 26 Household Relationships... 27 Household Information... 28 Additional Household Information... 29 Certification of Identity... 30 Absent Parent Details... 31 Long Term Care Details... 32 Additional Long Term Details... 33 Prior Residence... 34 Noncitizen Details... 35 Sponsor Details... 36 Alias Name / Social Security Number Details... 37 Household Information Details... 38 Pregnancy Details... 39 Details regarding pregnancy must be entered on this screen... 39 School Details... 40 Disability Details... 41 Disability Pamphlet... 42 Supplemental Security Income (SSI) Details... 44 Case Information... 45 Case Details... 46 Migrant Details... 47 Household Summary... 48 2
Asset Information... 51 Liquid Asset Details... 52 Life Insurance Details... 53 Vehicle Details... 54 Real Estate/Property Details... 55 Business Asset Details... 57 Asset Transfer Details... 58 Cash Settlement Details... 59 Asset Summary... 60 Employment Information... 61 Current Employment Income Details... 62 Past Employment Income Details... 63 Self Employment Income Details... 64 Room And Board Income Details... 65 Employment Summary... 66 Other Income Information... 67 Qualified Income Trust Details... 68 Other Income Details... 70 Application for Other Benefits Details... 71 Other Income Summary... 72 Insurance Information... 73 Medicare Details... 74 Medicare Premium Details... 74 Health Insurance Details... 75 Heath Insurance paid for by someone outside of the household... 75 Expense Information... 76 Housing Expense Details... 77 Utility Expense Details... 78 Child or Adult Daycare Expense Details... 79 Room And Board Expense Details... 80 Support Payment Details... 81 Past Medical Expense Details... 82 Medical Expense Details... 83 Blind Work Expense Details... 84 Expense Summary... 85 Case Summary... 86 3
Statement of Understanding... 90 Electronic Signature (in household)... 92 Electronic Signature (outside of household)... 93 Confirmation Page... 94 ACCESS Online Survey... 95 Adding Comments after Application Submitted... 96 4
ACCESS Web Application Process Flow Splash Page Welcome What Would you Like to do? Apply for benefits Complete an unfinished application Add comments to an application that you submitted User Login User Login Continue where previously left off. Application Comments My ACCESS Account and eligibility reviews. My ACCESS Account Login Benefit Choices Drug Testing Information Acknowledgement and Consent Release Requirements Relative Caregiver Program Eligibility Requirements Relative Caregiver Program Eligibility Requirements (court placed) Medicaid Important Information User Sign- up Applicant Information Address Validation Application Summary 5
Household List Rights & Responsibilities HIPAA Household Relationships Household Information Additional Household Information Certification of Identity Absent Parent Details Long Term Care Details Noncitizenship Details Alias Name / SSN Details Household Information Details Pregnancy Details School Details Disability Details Supplemental Security Income (SSI) Details Prior Residence Details Additional Long Term Care Details Sponsor Details Disability Pamphlet Case Information Case Details (Lifeline) Migrant Details Household Summary 6
Asset Information Liquid Asset Details Life Insurance Details Vehicle Details Real Estate/Property Details Business Asset Details Additional Real Estate/Property Details Asset Transfer Details Case Settlement Details Asset Summary Employment Information Current Employment Income Details Past Employment Income Details Self Employment Income Details Room & Board Income Details Employment Summary Other Income Information Qualified Income Trust Details Other Income Details Application for Other Benefits Details Other Income Summary 7
Insurance Information Medicare Details Medicare Premium Details Health Insurance Details Health Insurance Paid By Someone Outside of Household Details Expense Information Housing Expense Details Utility Expense Details Child or Adult Daycare Expense Details Room & Board Expense Details Support Payments Details Past Medical Expense Details Medical Expense Details Expense Summary Blind Work-Related Expense Details Case Summary Statement of Understanding E-Signature (inside HH) E-Signature (outside HH) Did not e-sign Confirmation Page ACCESS Online Survey Application Completed 8
ACCESS Florida Splash Page This is the ACCESS webpage that is the portal to the ACCESS Customer facing systems. 9
Welcome What Would You Like to do? If the customer clicks on this button, information displays which explains the screen The customer can choose the language in which they wish to complete the application. Information on the bottom half of the page tells the customer information they may need to complete the web application. The customer chooses which process they wish to complete. The customer has the following options: Click on Apply for benefits and the Continue button to begin the application process. Click on Complete a recertification review and the Continue button to begin the recertification process. Click on Complete an unfinished application or recertification review and the Continue button to complete an application or review that has already been started. (The customer must have the application number and password.) 10
Click on Add comments to an application that has been submitted using an Electronic- Signature to add comments to an application which has been submitted, but has not had processing started by the caseworker. (The customer must have the application number and password.) Report a change to my case this will drive them to the ACCESS FLORIDA change report system. My ACCESS Account will allow the customer to check the status of case and to view benefit information. 11
Benefit Choices 12
The customer must select whom they wish to apply for and for which benefits they wish to apply. Food Stamps Cash Assistance Medicaid HCBS / Waivers (Home and Community Based Services) Hospice Medicare Savings Program Simplified Eligibility for Pregnant Women Click on the icon next to each program for more detailed information about the program. 13
Drug Testing Information Acknowledgement and Consent Release This screen displays for customers who choose only Cash Assistance - Cash assistance for myself and my family 14
Relative Caregiver Eligibility Requirements This box displays to inform the caretaker relative of the option of Relative Caregiver assistance when the child has not been placed through the court. This screen is displayed when one of the following situations is indicated under Cash Assistance: Cash assistance for a child the court s placed with me Cash assistance for a child that is not mine but is related to me. 15
Medicaid The Medicaid screen displays if Medicaid is the only benefit the customer has choosen. It informs them of the option to apply for Medicaid for the children only and links to the Florida Healthy Kids application webpage. 16
Important Information 17
This screen informs the customer of the following: Application processing time standards for each program Answers provided during the application process determine if the household meets expedited food stamp criteria How to check the status of an application by using My Account Information regarding noncitizens and SSN Information regarding Fraud Information regarding computer matching 18
ACCESS Online User Sign-Up It is important to write down the ACCESS Online Number and password. They must have their Application Number and Password to return. It is very important that the customer remember their password. The customer should write down the application number. Explain that this will allow them to stop at any point and complete the application later. Once the customer has reached this screen, they have the ability to SAVE & QUIT the application, and return at a later time. The following message displays when the SAVE & QUIT option is selected: 19
Applicant Information The Applicant Information screen is the first screen in the Application It captures information about the name and address for the head of household. Progress Bar This feature tells the customer how far along they are in the application process 0% Complete Navigation Menu This feature shows the customer which screens are completed during the application process. It also allows them to navigate back to a specific screen This screen displays the Navigation Menu and the Progress Bar as a reference for the applicant. If the applicant answers YES to receiving mail at a different address, the additional address mailing fields must be completed to ensure correct delivery of mail. 20
Address Validation The address entered on the Application Information screen is validated based on information from the United States Postal Service for accuracy 21
Application Summary At the end of each section of the application you will see a summary screen. This allows the customer to review their entries up to this point and return to specific screens to make any changes or corrections. 22
Household List This screen is used to capture information about the household members. 23
When the customer clicks NO, the message Please add all members in the household even if you are not applying for them is displayed. The customer can then click CONTINUE to move to the next screen 24
Rights and Responsibilities The customer must use the scroll bar to read the entire Rights and Responsibilities The customer must click yes for the Rights and Responsibilities. 25
HIPAA The customer must use the scroll bar to read the entire HIPAA Statement The customer must click YES for HIPAA. 26
Household Relationships This question is displayed if the applicant indicated on the Benefit Choices screen that they are applying for food assistance. The customer must choose the relationship of all members of the household 27
Household Information The questions on this screen are dynamic, based on the type of assistance requested and the demographics of the individuals in the case. Information for the household is captured on this screen. Based on the entries made on this screen, detail screens are displayed. 28
Additional Household Information 29
Certification of Identity The screen is displayed when the application contains children under age 16. It allows the applicant to certify to the identity of those children 30
Absent Parent Details This screen will display when the individual is a child and both parents are not listed in the application. Information regarding the Absent Parent is entered on this screen. There may be multiple Absent Parent detail screens 31
Long Term Care Details 32
Additional Long Term Details 33
Prior Residence 34
Noncitizen Details 35
Sponsor Details 36
Alias Name / Social Security Number Details If an individual has an Alias name or Social Security Number, the information is entered on this screen. The drop down boxes provide the options for Alias Name Type and Social Security Number Type. 37
Household Information Details 38
Pregnancy Details Details regarding pregnancy must be entered on this screen 39
School Details Detailed information regarding school attendance is entered on this screen. Graduation date is mandatory if High School, Equivalent is selected for School Type. 40
Disability Details 41
Disability Pamphlet 42
Disability Pamphlet (cont) 43
Supplemental Security Income (SSI) Details 44
Case Information Additional information regarding the household is captured on this screen. 45
Case Details This screen captures additional information when the applicant states on the prior screen that they are interested in the discounted phone service (lifeline). 46
Migrant Details The Migrant Details screen is displayed if the applicant is applying for Food Assistance benefits and indicates there is a migrant in the household. It is used to determine eligibility for expedite services. 47
Household Summary The Household Summary screen allows the customer to see the information entered in this section of the application The customer may correct any information that was entered incorrectly by clicking on the Change button. This will return them to the detail screen to correct previous entries. 48
Household Summary (cont) 49
Household Summary (cont) 50
Asset Information Based on the entries made on the Asset Information screen, the following detail screens will be displayed: Liquid Asset Details Life Insurance Details Vehicle Details Real Estate Property Detail Business Asset Details Asset Transfer Details Cash Settlement Details 51
Liquid Asset Details Multiple assets can be entered if this entry is YES Detailed information regarding liquid assets is entered on this screen. The drop down boxes provide options for Type of Asset. 52
Life Insurance Details Detailed information regarding Life Insurance is entered on this screen. The drop down boxes provide options for Type of insurance. Multiple life insurance policies can be entered. 53
Vehicle Details Detailed information regarding vehicles is entered on this screen. The drop down boxes provide options for how the vehicle is used. Multiple vehicles can be entered. 54
Real Estate/Property Details Multiple properties can be listed if this entry is YES Detailed information regarding Real Estate/Property is entered on this screen. The drop down boxes provide options for Type of Property. 55
Additional Real Estate/Property Details 56
Business Asset Details Detailed information regarding Business Assets is entered on this screen. The drop down boxes provide options for Type of Asset. 57
Asset Transfer Details Detailed information regarding asset transfer is entered on this screen. The drop down box provides options for what asset was transferred 58
Cash Settlement Details 59
Asset Summary The Asset Summary screen allows the customer to see the asset information entered. The customer may change information by clicking on Change, which returns customer to the appropriate screen. 60
Employment Information Based on the entries made on the Household Employment screen, the following detail screens will be displayed: Current Employment Income Details Past Employment Income Details Self Employment Income Details Room and Board Income Details 61
Current Employment Income Details Detailed information regarding current employment is entered on this screen. The drop down box provides options for How Often Paid. Space is provided for the customer to enter comments regarding employment. The customer may enter up to 500 characters in the comments section. 62
Past Employment Income Details Detailed information regarding past employment is entered on this screen. The drop down box provides options for How Often Paid. Space is provided for the customer to enter comments regarding employment. The customer may enter up to 500 characters in the comments section. 63
Self Employment Income Details Detailed information regarding self employment income and expenses is entered on this screen. Multiple drop down boxes provides options for Type of Income and Type of Expense. 64
Room And Board Income Details 65
Employment Summary The Employment Summary screen allows the customer to see employment information entered. The customer may change information by clicking on Change, which returns customer to the appropriate screen. 66
Other Income Information Based on the entries made on the Other Income Information screen, the following detail screens will be displayed: Other Income Details Application for Other Benefits Details 67
Qualified Income Trust Details 68
Qualified Income Trust Details (cont) 69
Other Income Details Multiple Other Income amounts can be entered if this entry is YES Detailed information regarding Other income is entered on this screen. The drop down boxes provide options for Type of Income and How Often Received. 70
Application for Other Benefits Details 71
Other Income Summary The Other Income Summary screen allows the customer to see the non-employment income information entered. The customer may change information by clicking on Change which returns customer to the appropriate screen. 72
Insurance Information Based on the entries made on Insurance Information screen, the following screens will be displayed: Medicare Details Medicare Premium Details Health Insurance Details Health Insurance Paid by Someone Outside the Household Details 73
Medicare Details If an entry of YES is in these fields the Medicare Premium Details screen will be displayed. Medicare Premium Details 74
Health Insurance Details Details regarding Health Insurance must be entered. Drop down boxes provide options for Type and Coverage. Heath Insurance paid for by someone outside of the household If entry in Who pays for this policy is OTHER this screen will be displayed. Details regarding that individual must be provided. 75
Expense Information Based on the entries made on Expense Information screen, the following screens will be displayed: Housing Expense Details Utility Expense Details Child or Adult Daycare Expense Details Support Payments Details Room & Board Expense Details 76
Housing Expense Details Detailed information regarding Housing expense is entered on this screen. The drop down box provides options for Type of housing expense. 77
Utility Expense Details Detailed information regarding Utility expense is entered on this screen. The drop down box provides options for Type of utility expense. An entry of YES allows entry of multiple utility expenses. Another Utility Expense Details screen will be displayed. 78
Child or Adult Daycare Expense Details Multiple expense amounts can be entered if this entry is YES 79
Room And Board Expense Details Multiple expense amounts can be entered if this entry is YES Detailed information regarding Room and Board expenses is entered on this screen. The drop down box provides options for Number of meals per day. 80
Support Payment Details Multiple expense amounts can be entered if this entry is YES Detailed information regarding Support payment expense is entered on this screen. The drop down boxes provide options for Is this court ordered, Has court obligation been met and Relationship of dependent. 81
Past Medical Expense Details 82
Medical Expense Details 83
Blind Work Expense Details 84
Expense Summary The Expense Summary screen allows the customer to see the expense information entered. The customer may change information by clicking on Change which returns customer to the appropriate screen. 85
Case Summary Application Summary A summary of all information entered will be displayed. The customer may make changes to any entry at this point. The customer must scroll down to see all entries. 86
Household Summary 87
Asset Summary Employment Summary Other Income Summary 88
Expense Summary 89
Statement of Understanding 90
Statement of Understanding (cont) The customer must check the box stating they have reviewed and understand the Statement of Understanding. 91
Electronic Signature (in household) The customer may apply for benefits by clicking SIGN NOW or not submit an application by clicking SAVE & QUIT. If SIGN NOW is selected, a Confirmation Page will be received. 92
Electronic Signature (outside of household) 93
Confirmation Page The e-mail confirmation serves as a receipt for the customer to let them know their application has been received. This new section informs the customer if they are potentially eligible for expedited services and what to expect next in the process. The application has been completed and successfully submitted. 94
ACCESS Online Survey 95
Adding Comments after Application Submitted A customer may add comments to the application after it has been submitted. The customer must access the system and select Add comments to an application that has been submitted using an Electronic Signature 96
The customer must use the ACCESS Online Number and password to access the case. The comments can then be entered and saved. If the customer does not want to add or save the comments they can select Exit. The message below will be received if the customer selects Exit. 97