CIRI Screen 1
CY043S01 V85 F12 OKLAHOMA DEPT OF HUMAN SERVICES DATE: 04/30/20 PG: 01 TRANID: CIRI OCSS INFORMATION & REFERRAL INQUIRY TIME: 08:14:39
FGN: 000504XXX001 WRKER U7XXX8 WORKER, WALLY D OFFICE: STO IV-D STATUS: 02 PRTY: 1 STATUS DT: 06/08/05 CLOSE RSN: PU: Y TK: Y NCP NAME: HOMER J SIMPSON NCP DCN: 0041XXX90 NCP CLOSE RSN: =========================================== IVD: Y PASS: N = PDS: = FVS: = ** SSN ENTERED: NCP ENTERED: FGN ENTERED: 00050XXX001 ** NCP NAME: SIMPSON HOMER J LEGAL STATUS: A NCP ADDR: 123 MAIN ST SPRINGFIELD XX XXXXX-XXXX ADD VER: V VER DATE: 11/01/19 NCP POA: HOME: (405) 555-1234 WORK: (405) 555-9876 ET OTH: (405) 555-6543 TYP CELL NCP DOB: 04/25/79 SEX: M RACE: W SSN: 4XX-X0-0XX7 VER: Y MULTI: RELATED FGN: 000084XXX001 CH
CASE OPEN BY: DT: PS2 NO: C82XXX1 HCA NO: 1A2B3C BP NAME: SIMPSON MARGE R BP DCN: 038XXX785 CP NAME: SIMPSON MARGE R CP DCN: 038XXX785 CP ADDR: 742 EVERGREEN TER SPRINGFIELD OK 74XXX-0XX3 CP ADD VER: V CP VER DATE: 11/01/18 CP POA:
HOME: (405) 555-8888 WORK: (405) 555-7777 ET OTH:
CP SEQ: 001 CP DOB: 10/21/81 SEX: F RACE: W SSN: 4XX-X4-6XX9 VER: N MULTI: RELATED FGN: 000504XXX001 BP
01 – Application/Referral
02 – Active
04 – Closed
06 – Active arrearage only
08 – Active Judgment
10 – Open Uncollectible
1 – Current payments being made
2 – Current payments not being made
3 – Obligation not established
4 – Paternity not established
5 – AP location not established
6 – AP unknown
A – Support Order Established
B – Divorced, no child support order
H – Paternity established, no support ordered
I – Married/Separated, no support order
M – Paternity not established
N – Paternity disproved by CSED
P – Paternity acknowledged(209)
Address Verification and date
L – Last known address
V – Verified as current address
N- Verified as bad address
U – Address pending
verification
Other FGNs the parties are
associated and their role
The parties may have
additional cases that will
not fit on the screen
Adult and Family Services case number
and Oklahoma Health Care Authority
case number the CP is associated with.
If there is more than one CP on the case this screen will be repeated until all the
CPs information has been listed.
CIRI Screen 2
CY043S02 V85 F11 OKLAHOMA DEPT OF HUMAN SERVICES DATE: 04/30/20 PG: 02 TRANID: CIRI OCSS INFORMATION & REFERRAL INQUIRY TIME: 10:17:02 FGN: 000687XXX001 WRKER U8XXX7 WORKER, WALLY OFFICE: STO
IV-D STATUS: 02 PRTY: 2 STATUS DT: 07/17/17 CLOSE RSN: PU: Y TK: Y NCP NAME: HOMER J IMPSON NCP DCN: 0061XXX55 NCP CLOSE RSN: =========================================== IVD: Y PASS: N = PDS: = FVS: = BP NAME: SIMPSON MARGE BP POWER OF ATTY: IRS: OTC: REFERRED TO OTC 04/29/20 0002668 MOD 04/01/20 0002668 CURR CASE TYPE(S): M CBRI: 04/15/20 CURRENT ACCOUNT OBL SEQ/STAT/INTERSTATE TYPE/STAT: 001 A I A TOT MO SUPP: 222.50 TOT C.S.: 272.50 NUMBER BAD CHECKS: 00 FIXED MD: 50.00 CASH MD: 0.00 **PAST DUE** **COLLECTIONS** **ISSUED**
TOT PAST DUE: 2621.95 LAST PYMT AMT: 51.35 LAST ISSUE AMT: 51.35 TOT JUDG BAL: .00 LAST PYMT DTE: 04/27/20 LAST ISSUE DTE: 04/27/20 TOT AMT DUE: 2621.95 DISTRIBUTION: K WAGE ASSIG ISSUE TYPE: CS P CASE BVD: 01/14/20 TOT THIS MO.: 205.40 EFT/WARRANT: C FD: CS-XX-42 CURR SUPPORT: 205.40 EFT RETURN ITEM: N OAH: PAST DUE: .00
Date and amount referred
for IRS intercept
Date and amount referred OTC for
state tax intercept
Will also show amounts received and
date when state taxes are intercepted
Current case type:
A- TANF Incoming
Interstate
C – TANF Instate
I – Medical only
Incoming Interstate
M – Medical only
Instate
N- Non-Public
Assistance Interstate
P – Non-Public
Assistance Instate
Credit Bureau Referral Info
Date and status referred
Current account
Paid or closed account/zero balance
Account assigned to collections (we
no longer send to a collection
agency this just means that they are
reported as delinquent)
Obligation sequence
number and type
A – active
P – Pending
C – Concurrent
Interstate type
I – incoming
O – Outgoing
Referral Type
A – active
T – Terminated
P – Pending
TOT MO SUPP – total monthly child
support amount
TOT C.S. – total current support
including medical spousal,
judgments and other
Past due amounts
BVD – balance verified
date
Last payment received amount and
date
Distribution
K – Wage assignment
H – Oklahoma tax intercepts
I – IRS intercept
J - OESC
CIRI Screen 3
CY043S03 V85 F12 OKLAHOMA DEPT OF HUMAN SERVICES DATE: 04/30/20 PG: 03 TRANID: CIRI OCSS INFORMATION & REFERRAL INQUIRY TIME: 10:17:33 FGN: 000687XXX001 WRKER U8XXX7 WORKER, WALLY OFFICE: STO
IV-D STATUS: 02 PRTY: 2 STATUS DT: 07/17/17 CLOSE RSN: PU: Y TK: Y NCP NAME: HOMER J SIMPSON NCP DCN: 006129555 NCP CLOSE RSN: =========================================== IVD: Y PASS: N = PDS: = FVS: = BANKRUPTCY: N TYPE: COLLECTION AGENCY: N AGENCY: MEO: N NCP ATTORNEY NAME: CP ATTORNEY NAMES:
HEARING: 01/28/20 TIME: 08:30 TYPE: CT LOC: OCSS 223 MAIN ST SPRINGFIELD, XX XXXXX
LAST RVW INIT: 10/06/17 TYPE: DESK RESULT: NOCHANG COMPLETE: 10/06/17 MULTI-MOD: OFC: COMPLETE:
CHILDREN CP REL FV FIRST M LASTNAME BIRTH DT 209 GT RSLT GRAD DATE 001 001 BART R SIMPSON 10/21/10 Y
CASH MEDICAL TERM NOTICE SENT: RESOLUTION:
Bankruptcy information
If it indicates that there
is a bankruptcy certain
actions cannot be taken
Type indicates which
type of bankruptcy
Chapter 7 , 11 , 12 or 13
Indicates if the case is a medical
enforcement only case
Indicates last hearing
enter on the HEARL
screen
Always check HEARL for
the next upcoming
hearing as this
information may not be
for the next hearing date
Last time the case was reviewed for a
modification
Type: Desk, Standard, or Fast Track
Results:
Increase – child support increased
Decrease – child support decreased
NOCHANGE – no change in child
support
AP/CP/BPNOSERV – unable to serve
AP/CP/BPNOCOOP – no cooperation
NOJURIS – no jurisdiction to mod
NOCRITER- does not meet criteria for
mod
AP/CPNOCTRY – out of the country
and not a country that we have an
agreement with
If there is Multi-Mod
information on the case
Blank – No
Y – Yes
Office doing the multi-mod
Completion date
Children on the case
If a genetic test was done and results
Graduation date
Cash medical termination
information
CIRI Screen 4
CY043S04 V85 F11 OKLAHOMA DEPT OF HUMAN SERVICES DATE: 04/30/20 PG: 04 TRANID: CIRI OCSS INFORMATION & REFERRAL INQUIRY TIME: 10:19:18 FGN: 000687XXX001 WRKER UXXXXX WORKER, WALLY OFFICE: STO
IV-D STATUS: 02 PRTY: 2 STATUS DT: 07/17/17 CLOSE RSN: PU: Y TK: Y NCP NAME: HOMER SIMPSON NCP DCN: 0061XXX55 NCP CLOSE RSN: =========================================== IVD: Y PASS: N = PDS: = FVS: = IA ISSUE DATE: 11/05/18 IA TYPE: I INITIAL WAGE TYPE:
EMPLOYER SEQ: 003 MED5 SENT: Y DATE: 12/01/19 FEIN: 020XXX080 SEIN:
EMPLOYER: NUCLEAR POWER PLANT EMP STAT: V STAT DATE: 08/28/19 TPL: Y EMP ADDR: SECTOR 7-G SPRINGFIELD XX XXXXX-XXXX IA AMOUNTS: CS AMT PAST DUE AMT SPOUSAL AMT MED AMT OTH AMT TOTAL IA AMT
425.50 100.00 0.00 0.00 0.00 525.50 EMP LUMP SUM IWO: DATE: TYPE:
LIENS: PROPERTY 10/08/17 09 SPRINGFIELD COUNTY - ACTIVE
Date Income Assignment
first issued
IA Type
I – Initial
M – Modified
T - Terminated
Employer Info
Employer Sequence
Number, Name, Address,
Status date, and Third
Party Liability indicator
EMP STAT:
V – Information is current
and verified
L – Information is last
known
N – Employer not
associated with NCP
U – Employment not
verified
MED5 sent to employer
Y – Yes
N – No
Date MED5 sent
Income Assignment amounts
Total Arrears due as a lump sum
Date IA issued
Type:
Initial
Amended
Terminated
List of any existing property liens for this FGN
This screen may be repeated if there are additional employers listed on the APEU
screen. It will repeat until all active employers are displayed. Please keep the APEU
screen updated with only the current employer(s).
CIRI Screen 5
CY043S05 V85 F11 OKLAHOMA DEPT OF HUMAN SERVICES DATE: 05/04/20 PG: 05 TRANID: CIRI OCSS INFORMATION & REFERRAL INQUIRY TIME: 14:31:21 FGN: 000812XXX001 WRKER WORKER, WALLY OFFICE: STO
IV-D STATUS: 04 PRTY: 1 STATUS DT: 06/27/19 CLOSE RSN: 1A PU: N TK: Y NCP NAME: SIMPSON HOMER NCP DCN: 058XXX86 NCP CLOSE RSN: =========================================== IVD: N PASS: N = PDS: = FVS: = POLICY NBR: XXXXX1234 CARRIER: BLUE CROSS POLICY HOLDER: AP HOMER J SIMPSON CP NBR: 001 LAST NOTICE: CSM03 02/24/14 RECIPIENTS D.O.B. BEGIN DT END DATE COVRG TYPES BART SIMPSON 09/21/04 06/22/19 99/99/99 03 05 LISA SIMPSON 01/18/12 06/22/19 99/99/99 03 05
MAGGIE SIMPSON 03/02/17 06/22/19 99/99/99 03 05
POLICY NBR: XXXXX987 CARRIER: DELTA DENTAL POLICY HOLDER: AP HOMER J SIMPSON CP NBR: 001 LAST NOTICE: CSM03 02/24/14 RECIPIENTS D.O.B. BEGIN DT END DATE COVRG TYPES BART SIMPSON 09/21/04 06/22/19 99/99/99 10 LISA SIMPSON 01/18/12 06/22/19 99/99/99 10
MAGGIE SIMPSON 03/02/17 06/22/19 99/99/99 10
Policy number and
name of insurance
carrier
Policy holder name and role
CP sequence number
that the policy
applied to the
children in that CPs
care
Last medical document sent
and the date sent
Recipients of the coverage and their
date of birth
Beginning and end date of coverage
(if ongoing this will be all 9s)
Type of coverage provided by the
policy
01 – Hospitalization only
02 – Hospitalization INP PHYS
03 – Major Medical
04 – Accident coverage (non-auto)
05 – Prescription drugs
07 – Cancer or Dread Disease
10 – Dental Services
11- Hospitalization Surgery
12 – HMO
14 – Vision Care
Each policies will be listed separately
This screen may be repeated if there are additional insurance policies to be shown.
If this screen is blank then we do not have any insurance policies on file for this FGN.
