Participant Name Oretega, Fredy Region Taylor Street Service Center Moment 11/9/2021 11:16:00 AM Observation Type Electronic Observation ID 94698

Program * Select a program 100 - Medicaid Only 101 - Food Assistance (SNAP) Only 102 - Temporary Assistance for Needy Families (TANF) Only 103 - Advanced Premium Tax Credit (APTC) Only 104 - Medicaid, SNAP and TANF 105 - Medicaid and SNAP 106 - Medicaid and TANF 107 - SNAP and TANF 108 - Medicaid and District Medical Assistance or Other Cash Programs 109 - Interim Disability Assistance (IDA) 110 - POWER (Program on Work, Empolyment and Responsibility) 111 - General/Public Assistance 112 - DC Healthcare Alliance 113 - Any Other Program 114 - Non Program Specific/General Admin/Common to All Activity * Select an activity 200 - DCAS Intake 201 - DCAS Acceptance 202 - DCAS Eligibility Determination 203 - DCAS Outputs 204 - DCAS On-going Case Maintenance - Intake and Referrals 205 - DCAS On-going Case Maintenance - Customer Service Activities 206 - DCAS Community Based Application Assistance 400 - Outreach and Marketing 401 - Conduct/Participate in Program(s) Related Training, Conferences or Meetings 402 - Any Other Program Related Activity Case/Unique Identifier # IC 34145755 Comments (Mandatory) * processing app