| 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 |
| Date Paid | CURAM_DATE | Date that the payment was made by the household member to the organization. | No |
| Amount Paid | CURAM_AMOUNT | The monetary value of the payment made. This amount cannot be modified if an overpayment case has been created. | No |
| Payment Method | METHOD_OF_RECEIPT_CODE | Method of payment from the drop-down list of payment methods, e.g., "cash" or "check". Your system administrator can add a new payment method via the Code Tables page (see "Code Tables" in the Cúram Administration Guide). | No |
| Check Number | CHEQUE_NUMBER | The number of the check used to make the payment, if the payment method is "check". | No |
|
| Updated By |
| Label | Type | Description | Mandatory |
| Updated By | USER_NAME | | No |
|
|
|
| Pay In Details |
| Label | Type | Description | Mandatory |
| Household Member | FULL_NAME | Name and social security number of the household member to whom this pay in evidence applies from the drop-down list of household members. | No |
|
| Comments |
| Label | Type | Description | Mandatory |
| Comments | COMMENTS | | No |
|
