ALASKA FOOD STAMP MANUAL

Transcription

1 607 CLAIMS Claims are established against households receiving more food stamps than they are entitled to receive. Whether the overissuance was caused by agency error, inadvertent household error (client misunderstanding or failure to report) or intentional program violation (client fraud), collection must be attempted as outlined in this section. Exception: Agency-caused error claims less than $100 are not established. All adult household members are jointly and individually liable for the value of any overissuance of food stamps to the household. Agreement to repay, or payment of, the overissuance shall not relieve a household of civil or criminal liability, or from collection of the overissued food stamps under any other applicable provision of law. Nor does it relieve a household from payment of any additional amounts due from other overissuances identified later. For each food stamp overissuance discovered, the case worker is responsible for providing the Claims Unit in Juneau with a completed Report of Claim Determination (GEN 95). If a case worker discovers a claims alert for an individual reapplying for food stamps, the Claims Unit must be informed of the household's new address and program participation. See MS 607-1D for list of overissuances which do not require a claim. The Claims Unit is responsible for establishing the claim on EIS, sending the appropriate demand letters, and taking necessary actions to collect the claim. In addition, the Claims Unit determines when a claim should be pended or terminated. Adjustments to an established claim amount and transfers from one error cause category to the other will only be done by Claims Unit staff. I-1

2 607-1 TYPES OF OVERISSUANCES Reasons for establishing claims include an intentional program violation, client error, and agency error A INTENTIONAL PROGRAM VIOLATION (IPV): FRAUD Claims are identified as intentional program violations if the household member is convicted in a court, is judged to have committed fraud in an administrative disqualification hearing, or signs a waiver of the right to a disqualification hearing. See MS on Administrative Disqualification Hearings. IPV claims under $100 are pursued as a client error unless blatant intentional program violation appears to exist. Household members with pending court or hearing decisions are allowed to participate if otherwise eligible. Once established as an intentional program violation claim, household members not disqualified are responsible for the claims payment. The following are considered to be intentional program violations: (1) A false or misleading statement is made to the state agency either verbally or in writing to obtain food stamp benefits to which the household is not entitled. (2) Information is concealed, misrepresented, or withheld to obtain food stamp benefits to which the household is not entitled. (3) Failure to report changes in household circumstances as required to obtain food stamp benefits to which the household is not entitled. (4) Reissuance for food stamp benefits already received are requested. (5) Food stamp benefits are used to buy items which are not eligible, such as alcohol or cigarettes. (6) Improperly obtained food stamp benefits are used or possessed. (7) Food stamp benefits are sold or traded. (8) An act is committed which constitutes a violation of the Food Stamp Act, the Food Stamp Program regulations, or any state statute relative to the use, presentation, transfer, acquisition, receipt or possession of food stamp benefits. I-2

3 607-1B INADVERTENT HOUSEHOLD ERROR (IHE): CLIENT ERROR Client error, also referred to as inadvertent household error, includes, but is not limited to: (1) Client failure to report that was not done knowingly, willfully, or with deceitful intent to defraud, including: (a) (b) (c) (d) Failure to provide the agency with correct or complete information. Failure to report at all. Failure to report changes timely. Failure to report changes correctly. (2) The household was eligible for fewer food stamp benefits or ineligible pending a fair hearing decision, but received continued benefits and the hearing decision was rendered against the household. (3) The household received benefits on a quarterly or semiannual basis and was overpaid due to a reportable change in household circumstances C AGENCY ERROR Claims considered to be agency errors include: (1) The agency failed to take timely action on a reported change. (2) The agency assigned an incorrect allotment. (3) The agency issued duplicate food stamp benefits in error which the household transacted. (4) The agency computed income, expenses, deductions, or allotment incorrectly. (5) The household continued to receive food stamp benefits after the certification period expired. (6) The agency failed to effect an allotment change due to an ATAP grant change. (7) The agency made any other error that resulted in incorrect food stamp benefits issued. I-3 MC #8 (9/02)

4 607-1D OVERISSUANCES THAT DO NOT REQUIRE CLAIMS No overpayment claim exists when: (1) An unanticipated change in income or household circumstances occurs after the benefit is already issued. There is no claim for benefits issued prior to the effective date of the change. See MS 604-3D for policy on effective date of change. Subsequent months may be incorrect and require a claim. Example: A household has no income. Its application is approved and benefits are issued on May 4. On May 15, one of the members obtains employment and receives his first paycheck on May 22. Regardless of whether or not the household member reported receipt of this income, benefits could not have been adjusted for May and no loss to the program has occurred. A claim determination is not completed for May. (2) A household is allowed a deduction for an expense and the household never pays the expense. Food stamp rules allow deductions when the expense is incurred, regardless of when or if it is paid. See MS (3) The agency fails to insure the household: Signed the application; or, Provided or applied for a social security number. (4) The agency-caused overpayment claim amount is less than $100. Use the total of the overpayment amounts for all the months in the claim determination. If the total is less than $100, do not submit the claim. I-4 MC #8 (9/02)

5 607-2 CLAIM ESTABLISHMENT, COLLECTION, AND TERMINATION 607-2A ESTABLISHING A CLAIM When information is received indicating a claim may exist: (1) Ensure the household's current food stamp budget reflects correct information to avoid further incorrect issuances. (2) Obtain written verification of any questionable issues. (3) Inadvertent household error and agency error claims are calculated back no more than 12 months prior to the month of discovery. Intentional program violation claims are calculated back to the month the fraudulent act occurred, but no more than six years from the date the overissuance was discovered. When the claim is due to IPV or an error at application, the claim is effective with the first month food stamps were incorrectly issued. When the overpayment is caused by a change during the certification period, it is effective with the allotment which should have been changed had the client and agency acted correctly. Allow for adverse action notice and time required for the issuance to take effect. (4) Cancelled benefits are not included in the claim. (5) Calculate what should have been issued for each month of the period in question. When circumstances automatically cause ineligibility, such as excess resources, assume the amount that should have been issued is zero and the overpayment is the value of the allotment issued. In calculating what should have been issued: (a) (b) (c) (d) Include household members who would have been part of the household based on the effective date of change policy at MS 604-3D. Budget correct income actually received by the household (not projected amounts). Include any unreported household member s income. Income may be averaged when attempts to obtain actual amounts have been pursued and documented. When an IPV fraud or client-caused error claim amount is calculated, the 20 percent earned income deduction is not applied to that portion of earned income the household failed to report timely. Allow only expenses previously claimed and budgeted. I-5 MC #8 (9/02)

6 607-2A Cont. (6) Compare what was issued to what should have been issued. If this comparison shows no difference, no claim exists. When there is a difference, proceed to step 7. (7) If the household is eligible for restored benefits and has an outstanding claim balance, the restored benefit amount must be applied as payment to the claim. See MS Exception: Initial month allotments shall not be reduced to offset a claim even if the allotment is paid retroactively. See MS 600-2, for definitions of "initial month" and "initial benefit". (8) Evaluate the claim for possible fraud. Obtain supervisory approval of the recommendation for claim action. If fraud is involved, a fraud referral report form is completed. If no fraud is involved, a claim determination form is completed. (9) Submit the approved fraud referral form to the DPA Fraud Control Unit for action as a fraud/intentional program violation. Submit the approved claim determination form to the Claims Unit for establishment as an agency or client error claim B COLLECTING CLAIMS All food stamp claim collection actions are taken by the Claims Unit. The Claims Unit sends demand letters, receives repayment agreements, collects repayments and completes action to suspend, terminate, or close a claim. For claims collection in households with sponsored aliens see MS 605-2A and I-6

7 607-2B Cont. (1) Repayment Letter and Agreement A demand letter with a repayment agreement is sent to the household for every established client error and IPV claim and every agency error claim $100 or more. Demand letters are not sent if the claim is pended, terminated, or waiting prosecution or an administrative disqualification hearing decision. The household must respond to the request for payment and establish a repayment schedule. The household may request renegotiation of the repayment agreement at any time. However, the Claims Unit will only renegotiate if it agrees that changed circumstances warrant a revised repayment schedule. (2) Methods of Repayment The household will be given an opportunity to choose a repayment method. Repayment will be by cash, check, money order, allotment reduction, or by food stamps. Repayments submitted to a district office must be forwarded to the Claims Unit. See MS 606-1A for instructions on transmittal of food stamps. (a) Lump Sum Claims will be collected in one lump sum whenever possible. (b) Installments Payment may be in regular installments if the household is financially unable to pay the claim in one lump sum. The Claims Unit will develop an installment plan to collect the full amount of the claim in as short a time as possible. The amount of the monthly payment for client errors and IPVs must not be less than the amount the household would have been required to pay through allotment reduction. Once the amount is determined, it remains unchanged unless the Claims Unit or the client initiate renegotiation of the payment schedule. I-7

8 607-2B Cont. (c) Allotment Reduction Allotment reduction may be selected by any household still participating in the program. Allotment reduction is initiated for all claims if there is no timely response or failure to make scheduled payment. EIS calculates these allotment reductions. The reduction amount will be: Intentional program violation claims (fraud): 20 percent of the household's entitlement or $10, whichever is greater. Client error and agency error claims: 10 percent of the allotment or $10, whichever is greater. (3) Failure to Respond Participating households not responding to a demand letter within 10 days will have their allotments reduced regardless of whether a disqualification penalty is currently being imposed. These households will not receive notice of adverse action. (4) Failure to Make Payment When a household fails to make a payment on a claim as agreed in the repayment plan, the allotment will be reduced if the household is currently participating. If the household is not currently participating a reminder notice is sent. I-8

9 607-2C STATUS OF CLAIMS An established claim is considered active until it is pended, terminated or closed by the Claims Unit, regardless whether a repayment agreement is signed or repayment is made. Claims are pended or terminated by the Claims Unit when collection attempts have proven unproductive or not possible. All restored benefits due a household must be used as payment to offset active or pended claims. (1) Pended Claims The Claims Unit may pend a claim if: (a) (b) (c) The household cannot be located. The household has been sent at least one demand letter for any claim under $100, two demand letters for any claim between $100 and $499, or three demand letters for any claim more than $499. The cost of further collection action is likely to exceed the amount that can be recovered. (2) Termination of Claims A claim for which no payment is made for three years is terminated. (3) Closure of Claims A claim is closed when the total overissuance has been repaid. I-9

10 607-3 INTERSTATE CLAIMS COLLECTION In cases where a household moves out of Alaska, collection action against the household for an overissuance which occurred while the household was in Alaska will be pursued by the Claims Unit. The state which overissued benefits to the household shall have the first opportunity to collect the overissuance. However, if that state does not take prompt action to collect, then the state from where the household recently moved should initiate action to collect the overissuance. I-10

11 607-4 CLAIMS AGAINST SPONSORS AND SPONSORED ALIENS 607-4A COLLECTING CLAIMS AGAINST SPONSORS (1) The Claims Unit initiates collection action by sending the alien's sponsor a written demand letter which informs the sponsor of the amount owed, the reason for the claim, and how the sponsor may pay the claim. The sponsor shall also be informed that the sponsor will not be held responsible for repayment of the claim if the sponsor can demonstrate that he/she had good cause or was without fault for the incorrect information having been supplied to the district office. The sponsor is entitled to a fair hearing either to contest a determination that the sponsor was at fault where it was determined that incorrect information has been provided or to contest the amount of the claim. (2) If the alien's sponsor responds to the written demand letter and is financially able to pay the claim at one time, the Claims Unit will collect a lump sum cash payment. The Claims Unit may negotiate a payment schedule with the sponsor for repayment of the claim, as long as payments are provided in regular installments B COLLECTING CLAIMS AGAINST ALIEN HOUSEHOLDS Prior to initiating collection action against the household of a sponsored alien for repayment of an overissuance caused by incorrect information concerning the alien's sponsor or sponsor's spouse, the case worker will determine whether such incorrect information was supplied due to inadvertent household error or an act of intentional program violation on the part of the alien. I-11

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