Attachment III
Recipient Referral Information
Current Referral File Data Elements
Application Date
Case Name
Application/Referral Type
Address
County Code
A/R - First Name, Last Name and Middle Initial
Date of Birth
Sex
Social Security Number
Added Data Elements
Client Identification Number (CIN)
State/Fed Charge Code
State /Fed Charge Date
Relationship to Account Holder
Alien Code Indicator (ACI)
Alien Number
Alien Date of Status
Alien Date of Entry
Plan Identification Code (PID)
Individual Categorical Code