| Label | Type | Description | Mandatory |
| Updated On | CURAM_DATETIME | The date on which the last update was made to the evidence. | No |
| Effective Date of Change | CURAM_DATE | Date which the evidence becomes effective | No |
| Approval Requested | CURAM_INDICATOR | Approval Requested | No |
| Annuity Type | EVD_ANNUITY_TYPE | Annuity type, e.g., immediate or long-term from the drop-down list of annuity types. Your system administrator can add a new annuity type via the Code Tables page (see "Code Tables" in the Cúram Administration Guide). | No |
| Annuity Category | EVD_ANNUITY_CATEGORY | Annuity category from the drop-down list of annuity categories, e.g., revocable, irrevocable. An irrevocable annuity cannot be revoked by the purchaser whereas a revocable annuity can. | No |
| Date Established | CURAM_DATE | The date on which the annuity was created. | No |
| End Date | CURAM_DATE | The date on which the annuity ends. | No |
| Source of Funds | EVD_SOURCE_OF_FUND | Source of the annuity fund from the drop-down list of sources, e.g., annuitant, annuitant's spouse, other. This is the case participant whose funds or assets are used to establish the annuity, for example, annuitant or annuitant's spouse. | No |
| Annuity Value | CURAM_AMOUNT | The monetary value of the funds or assets held in the annuity. | No |
| Recoupment By State | CURAM_INDICATOR | Select the Recoupment By State selection box to indicate if any amount remaining in the annuity will be paid to the State upon the death of the individual, up to the amount of medical services paid by Medical Assistance. | No |
|
| Updated By |
| Label | Type | Description | Mandatory |
| Updated By | USER_NAME | | No |
|
|
|
| Institution Details |
| Label | Type | Description | Mandatory |
| Institution Type | EVD_ANNUITY_INSTITUTION_TYPE | Institution type, e.g., bank, insurance company from the drop-down list of institution types. Your system administrator can add a new institution type via the Code Tables page (see "Code Tables" in the Cúram Administration Guide). | No |
|
| Institution Participant |
| Label | Type | Description | Mandatory |
| Institution Participant | FULL_NAME | Institution who established the annuity from the drop-down list of case participants. Note that the system displays the primary alternative ID of each of the case participants displayed on the drop-down list. In the US, the primary alternative ID is the social security number (SSN). | No |
|
| Comments |
| Label | Type | Description | Mandatory |
| Comments | COMMENTS | | No |
|
