To provide the EBT PIN vendor and local office staff with a method of verifying EBT PIN order discrepancies.
The EBT PIN vendor prepares this form when sending a PIN order that contains a shortage.
The local office prepares this form when it receives a PIN order that contains a discrepancy (unidentified shortage or overage).
Prepare one self-carboning form.
The local office retains the original for audit purposes and forwards the copies to the EBT Regional Security Officer.
The EBT Regional Security Officer forwards a copy to the
Retain the original for three years.
Number — The vendor or local office staff enters the number of PINs the order was short.
Missing Sequence Numbers — The vendor or local office staff enters the sequence number(s) for the missing PINs.
1. Signature — The vendor's staff person signs to verify the information.
2. Name — The vendor's staff person prints his name.
3. Date — The vendor's staff person enters the date.
1. Order Number — Enter the order number that contains the discrepancy.
2. Date Ordered — Enter the date ordered.
3. Date Order Received — Enter the date the order was received in the local office.
Number — Enter the number of excess PINs.
Extra Sequence Numbers — Enter the sequence numbers of the extra PINs. EBT security procedures require that two persons in the local office verify the shortage or overage. The first person completes Items 4 through 10 and the second person completes Items 11 through 17.
4. and 11. Signature — Local office staff signs to verify the discrepancy.
5. and 12. Name — Print the name of the local office staff person verifying the discrepancy.
6. and 13. Title — Enter the title of the person verifying the discrepancy.
7. and 14. Office — Enter the office name and address.
8. and 15. Mail Code — Enter the office mail code.
9. and 16. Phone Number — Enter the phone number, including area code of the person verifying the discrepancy.
10. and 17. Date — Enter the date the form is completed.