MEMORANDUM

2009 Memorandums

IM-#63      08/31/09

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI
TO:
ALL COUNTY OFFICES
FROM:
ALYSON CAMPBELL, DIRECTOR
SUBJECT:
FOOD STAMP REPLACEMENT REQUESTS
FOOD STAMP MANUAL REVISION #29
1150.000.00
1150.005.00
1150.010.00
FORMS MANUAL REVISION #12: IM-110 REPLACMENT REQUEST FORM AND INSTRUCTIONS

DISCUSSION:

This memorandum introduces a revised IM-110 Replacement Request form, discusses policy and procedures for requesting a replacement of Food Stamp benefits, and addresses questions that have been raised by staff regarding replacements.

New IM-110 Replacement Request form

The Statement of Loss/Replacement Request (IM-110) and Replacement/Affidavit for Food Stamp Benefits Lost from an EBT Account (IM-113) have been combined. The new IM-110 form has been renamed Replacement Request, and includes the following changes:

This form can be completed by a member of the Food Stamp EU or the authorized representative.

EU’s Statement of Loss

The report of loss may be made by telephone, mail, or in person, however a member of the EU or an Authorized Representative must sign the IM-110 Replacement Request form before processing.

Verification of Loss

Replacement During Appeal

If a replacement is totally or partially denied the EU has the right to request a fair hearing. However, no replacement can be made while the denial is being appealed.

Submitting the Request

Continue to send completed IM-110 Replacement Request forms with verification as soon as possible to ColeFSPolicy@dss.mo.gov, or fax to 573-522-4333. If there is a delay in getting verification, to ensure meeting timeframes, send the IM-110 with a note describing verifications requested or attempts to obtain verification. File the original copy of the IM-110 in the case file.

County Determinations

During a disaster, county staff may be given access to complete these replacements. Refer to FAMIS User Guides Replacing Food Destroyed by a Household Misfortune. For replacement decisions made and entered by the county, a copy of the IM-110 must be sent to the Food Stamp Program and Policy Unit. File the original in the case record.

Before issuing a replacement benefit, check the Payment History (FM5F) screen for a replacement issuance to avoid duplicate issuances. If a replacement has been issued to the EU, a second request may be made if the EU has discovered an additional loss exceeding the original request. The total replacement cannot exceed one month’s benefits. If the EU has completed more than one request contact the EU to determine the total amount of the loss. If two replacement requests are made for the same loss, deny the second request. Notify the EU of each decision by sending an IM-112 Action Taken on Your Food Stamp Case. For losses due to power outage, the power must be out at least 4 hours before a replacement can be made.

Form Availability

The WORD version of the IM-110 Replacement Request form and instructions are available on the Intranet. The combination IM-110/113 form will not be available from the warehouse. Continue to use all current copies of the IM-110 and IM-113 forms to depletion.

Food Stamp Manual Revisions

The following Food Stamp Manual sections and FAMIS User Guides have been updated to include this change:

NECESSARY ACTION:

SW


2009 Memorandums