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.
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.
Determine the total number of months the EU received an overpayment for each claim period.
Calculate an AE claim back no more than twelve months including the month of discovery.
EXAMPLE: A possible overpayment for March 2003 through June 2003 is discovered on May 6, 2004. The 12-month look-back period is June 2003 through May 2004. A claim is established for the month of June 2003 only. Do not establish a claim for March 2003, April 2003, and May 2003.
Calculate an IHE claim back no more than twenty-four months including the month of discovery.
EXAMPLE: A possible overpayment for March 2002 is discovered on May 6, 2004. The 24-month look-back period is June 2002 through May 2004. A claim is not established.
A look back period of thirty-six months is allowed for SPV/IPV claims. If a suspected program violation overpayment month occurred within the thirty-six month look back period, calculate the overpayment back for seventy-two months. If there is no month in which an overpayment occurred due to the suspected program violation within the look back period, a claim amount is not calculated, and the discovery is rejected. The look back period includes the month of discovery.
EXAMPLE: A possible overpayment for March 2000 through June 2001 is discovered on May 6, 2004. The 36-month look-back period is June 2001 through May 2004. Since one of the months of the claim period falls into the 36-month look-back period, a claim is established for the entire claim period.
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.
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
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.