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Proof of Eligibility: Agency Information

This document provides eligibility information for Patricia K Hardcastle. It includes her case number, date of birth, mailing and home addresses, and details on her pending SNAP and Medicaid applications. For SNAP, her case is pending with a benefit amount of $232 for November and October. For Medicaid, she has been approved since July 2019 under Hoosier Care Connect or Traditional Medicaid.

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Demetris Noble
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1K views2 pages

Proof of Eligibility: Agency Information

This document provides eligibility information for Patricia K Hardcastle. It includes her case number, date of birth, mailing and home addresses, and details on her pending SNAP and Medicaid applications. For SNAP, her case is pending with a benefit amount of $232 for November and October. For Medicaid, she has been approved since July 2019 under Hoosier Care Connect or Traditional Medicaid.

Uploaded by

Demetris Noble
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Agency and Case Information
  • Assistance Group Details

*FSS409AE001TG1NV32F*

Proof Of Eligibility
State Form 53549 (R2 / 6-20) FI 2430 / IEDSS

Mailing Date: JANUARY 31, 2022


Agency Information
Family and Social Services Administration Document Center
PO Box 1810
Marion, Indiana 46952
Telephone: 1-800-403-0864

Case Information
Full Name: Patricia K Hardcastle Date of Birth: 07/18/1979
Case Number: 6006770410 Mailing Address:

Home Address: 1255 N Ritter Ave


Indianapolis IN 46219-3022

Scheduled Appointment
Appointment Type Appointment Date Scheduled Time Office Location

Pending Applications
Programs Applied For Date Application Received Case Number

Assistance Groups
Type of Assistance: SNAP Aid Category: SNAP Emergency Services Only: N/A
Details
Status: Pending EBT Card Benefit Available Date: NOVEMBER 06, 2021
Case Number: 6006770410 Current Month Amount: $232.00
AG Number: 33596425 Next Month Amount: $232.00
Effective Date: OCTOBER 20, 2021 Redetermination Month:
End Date: Monthly Liability (Health Coverage):
Previous Months Benefit Amount: ; November: $232.00; October: $89.00
Assistance Group Clients
Names Participation Status Effective Date End Date
Patricia K Hardcastle Eligible OCTOBER 20, 2021
Authorized Representative
Primary Name Primary Address

Page 1 of 2 G0000001000001000001
*FSS409AE002TG1NV32E*

Assistance Groups
Type of Assistance: Hoosier Aid Category: MASI Emergency Services Only: No
Care Connect or Traditional
Medicaid
Details
Status: Approved EBT Card Benefit Available Date:
Case Number: 6006770410 Current Month Amount:
AG Number: 22052345 Next Month Amount:
Effective Date: JULY 01, 2019 Redetermination Month:
End Date: Monthly Liability (Health Coverage):
Previous Months Benefit Amount: N/A
Assistance Group Clients
Names Participation Status Effective Date End Date
Patricia K Hardcastle Eligible JULY 01, 2019
Authorized Representative
Primary Name Primary Address

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