Special Allowance Case Narrative Template
The CAO must narrate the basis for issuing a SPAL in the case record. The CAO may use the template below to assist in narration of relevant details.
Blank Template for an Approved SPAL
1. Name of client and line #
2. Date SPAL was requested
3. Allowance requested with Reason Code
4. To support participation in ______ Program and _____ Activity Code – must be indicated on EDP
5. Timeframe of the allowance (from/to)
6. Date of authorization
7. Approval amount and explanation of calculation (i.e. participation days, MapQuest, schedule, etc.)
8. Forms that were completed and verification they were scanned (i.e. SPAL Verification Form, Estimates, etc.)
9. Remainder of Annual or Lifetime Limit (obtained from SPAL tracking screens)
10. PA162 notice of eligibility or ineligibility sent.
11. Explained that a receipt is due to the CAO by ________ (14 days - exception is mileage).
EXAMPLE- Narrative completed using template:
1. Angelica Tree – Line 01
2. Requested SPAL on 1/2/2018
3. Bus Pass (268)
4. Participating in SNAP 50/50 (AC 84)
5. SPAL supports participation from: 1/7/18 to 1/31/18
6. Authorized SPAL on 1/4/2018
7. $83 bus pass for January authorized.
8. EDP and PA 1883 scanned
9. $1085 remains available for Transportation/Annual Limit in FY 17/18 after this SPAL issuance
10. Manual PA162 notice of eligibility sent and scanned
11. Told Ms. Tree that a receipt to verify the purchase of a monthly bus pass is due to the CAO by 1/18/2018
Issued May 19, 2021