1142.035.00 COMPUTING THE AMOUNT OF THE CLAIM

IM-#40 May 28, 2008IM-#142 December 2, 2005

The amount of the claim is computed by determining the number of months of an overpayment and the amount of overpayment for each month. Whether an overpayment occurred is impacted by the EU change reporting requirements. Do not consider an overpayment has been made if the EU was not required to report the change in circumstances.

The first month of overpayment is determined by applying the change reporting rules that would have applied to the case situation if all facts and figures required to be reported had been reported to the agency within the proper time frames.

If the overpayment occurred because incorrect information was given or an incorrect determination was made at the time of an application or reapplication, the first month benefits were overpaid is the beginning month of the certification period.

EXAMPLE: Mr. B applies for Food Stamp benefits on 8/5/2004, and is approved for 08/2004 issuance. He does not report SSI income he has been receiving since 2001. SDX is received by the county office on 10/3/2004. The claim for overissuance when the SSI income is budgeted begins with 08/2004 because the income was not reported at application.

If the EU reports the change timely and action is required, but the worker fails to act on the change, the first month of overpayment is the first month the agency should have made the change effective. If the notice of adverse action was required but was not sent, the agency shall assume that the maximum advance notice period, if applicable, would have expired without the EU requesting a fair hearing.

EXAMPLE: Mrs. J applies for Food Stamp benefits on 8/5/2004 and reports all income. On August 26, 2004, Mrs. J reports she began a new job on August 25, 2004 and her income exceeds 130% of the poverty level. The worker does not act on the reported change. Mrs. J reapplies for Food Stamp benefits on January 18, 2005, and the worker discovers she is ineligible for Food Stamp benefits. The claim is done as an agency error beginning October 2004.

1142.035.05 Overpayment Period

IM-#40 May 28, 2008IM-#142 December 2, 2005

Determine the total number of months the EU received an overpayment for each claim period.

1142.035.10 Determining the Amount of the Claim

IM-#52 May 30, 2013, IM-#36 April 22, 2010IM-#40 May 28, 2008IM-#142 December 2, 2005

The eligibility specialist (ES) responsible for establishing the claim obtains the needed information and computes a budget for each month of the overpayment period using the Worker Initiated Budget Calculation Area (WIBCA) in FAMIS. Refer to the FAMIS User Guide WIBCA for instructions.

The correct benefit amount for each month as determined from the WIBCA budgets and the amount actually received by the EU is entered in the Claims and Restitution System (CARS.) CARS uses this information to determine the overpayment amount.

The ES identifies all responsible EU members in CARS; the system then tracks payment responsibility for each person. The claim is established when CARS generates the demand letter.

For trafficking claims, the Welfare Investigation Unit (WIU) determines the amount of the claim as part of their investigation. WIU notifies the worker of the period of time in which trafficking occurred and the amount of benefits that was used inappropriately. This determines the claim period and the claim amount.

1142.035.10.05 Determining the Amount of the Claim for Simplified Reporting EUs

IM-#52 May 30, 2013, IM-#36 April 22, 2010IM-#40 May 28, 2008IM-#142 December 2, 2005

Beginning May 1, 2010 all EUs are subject to simplified reporting requirements. Beginning June 1, 2013 act on all changes reported or known to the agency.

Use this link to view a document which contains the obsolete Food Stamp Program and Policy Manual sections which included simplified reporting without acting on all changes.

An EU is only required to report changes that cause the total gross EU income to exceed 130% of poverty or a change in ABAWD status.

Changes that are reported or known by the agency and required to be acted on must be considered in determining a claim. Changes that are not required to be reported and are not known to the agency are not considered when establishing a claim.

If… Activity Result
the EU was correctly determined eligible and the benefit amount accurately computed at application, and The change was not required to be reported. There is no claim.
the EU was not eligible and/or the budget was not done correctly at application resulting in an overpayment, prior to establishing the claim: Compute a corrected determination of the income being received at application to determine the corrected amount of the benefit. Use the corrected budget for each month of the claim. Do not use each month's actual income.
a change is required to be acted on and the budget was not done correctly resulting in an overpayment, prior to establishing the claim: Compute a corrected determination of the income being received at the time of the budget adjustment to determine the corrected amount of the benefit. Use the corrected budget for each month of the claim. Do not use each month's actual income.
the possible overpayment is due to non-report of a change required to be reported or failure to take required action: Determine whether the EU is overpaid for all or part of the certification period. Compute the claim amount using actual income to determine the amount of benefit the EU was eligible to receive each month.

NOTE: In situations where all efforts to obtain actual income have failed and the claim period covers the entire quarter and the income information is consistent on IMES, this source of income verification may be used to calculate the overpayment.

If the EU fails to report a change that caused the total EU income to exceed 130% of poverty and ineligibility exists for only a portion of the certification period, determine a corrected actual income amount for the month income exceeds 130%. Then, using the new amount of income, determine a new amount of benefit. Use the new benefit for the remaining months of the certification within the claim period. Include any income or change that was reported or known to the agency.

EXAMPLE: Mr. Andrews is approved for Food Stamp benefits of $371 for a three person EU with zero income March 1. At the August recertification interview, it is discovered Mr. Andrews began employment, at $500 weekly beginning March 15 and did not report it. His income exceeds 130% of poverty. Applying change reporting rules, a claim is calculated beginning May. His hours are cut back with checks beginning June 1 and he earns only $250 weekly. A trial budget is completed with $250 weekly, and the EU is eligible for $86 Food Stamp benefits for June. Daughter, Angela, leaves the home June 1, which is not required to be reported, and is not reported. Angela is removed for the claim amount determination and is not a responsible member of the claim

1142.035.10.10 Determining the Amount of the Claim for Change Reporting EUs

IM-#52 May 30, 2013

For claim periods prior to May 1, 2010 (when simplified reporting went into effect for all EUs) use this link to view a document which contains the obsolete Food Stamp Program and Policy Manual sections which included change reporting requirements.

Prior to May 1, 2010 to determine a claim amount for an EU when the change reporting requirement is not simplified reporting use these following guidelines.

NOTE: In situations where all efforts to obtain actual income have failed and the claim period covers the entire quarter and the income information is consistent on IMES, this source of income verification may be used to calculate the overpayment.