2005 Case Contents/Submission of Material to PRICE for Error Cause Codes of Agency (AG), Client (CL) and Documented Evidence (DE)
All documentation which supports an overpayment(s)/claim(s) should be sent to the state office, PRICE unit.
A. Submit overpayment(s)/claim(s) for SNAP, with the completed DFS-710 Overpayment Coversheet which has also been signed by the Benefit Specialist Supervisor and include, the date of discovery (the date the potential overpayment is identified by the eligibility worker). Send this form along with copies of the following:
1. Case narrative to cover the time period of the overpayment(s)/claim(s) including, but not limited to what caused the overpaid benefits, how it was discovered and what action was taken;
2. DFS-100 Application(s) for Benefits which cover(s) the time frame of the overpayment(s)/claim(s);
3. All evidence which supports the overpayment(s)/claim(s), i.e. DFS forms, rent receipts, rental agreements, bank records, employer statements, wage stubs, etc.;
4. EPICS screen prints:
a. CAP1, CAP2, CLPR, SSDO, DIRE, REHI, SEPA, FSBH and FSIH;
b. OVCA screen for each overpayment(s)/claim(s); and,
c. First Notice of SNAP Overpayment, all pages (F903).
5. Original 707 when available; and,
6. If appropriate, copies of all decisions from any disqualifications, administrative hearings or legal actions.
B. Submit overpayment(s)/claim(s) for POWER, with the completed DFS-710 Overpayment Coversheet which has also been signed by the Benefit Specialist Supervisor, and include the date of discovery (the date the potential overpayment is identified by the eligibility worker). Send this form along with copies of the following:
1. Case narrative to cover the time period of the overpayment(s)/claim(s) including, but not limited to what caused the overpaid benefits, how it was discovered and what action was taken;
2. DFS-100 Application(s) for Benefits which cover(s) the time frame of the overpayment(s)/claim(s);
3. All evidence which supports the overpayment(s)/claim(s), i.e. DFS forms, rent receipts, rental agreements, bank records, employer statements, wage stubs, etc.;
4. EPICS screen prints:
a. CAP1, CAP2, CLPR, SSDO, DIRE, REHI, AFBH and AFIH;
b. OVCA screen for each overpayment(s)/claim(s); and,
c. First Notice of POWER Overpayment, all pages (A903).
5. Original 707 as this is a performance requirement for a continued POWER performance payment, unless the overpayment was due to agency error; and,
6. If appropriate, copies of all decisions from any disqualifications, administrative hearings or legal actions.
C. When submitting overpayment(s)/claim(s) for all other programs not supported by EPICS (i.e. supportive services for work programs, child care recipients, non-client overpayments travel allowances, social services expenditures, etc.) include the following:
1. Completed DFS-710 Overpayment Coversheet which has also been signed by the Benefit Specialist Supervisor, and include the date of discovery, date(s) of ineligibility and amount(s) overpaid;
2. Case narrative (if applicable) to cover the time period of the overpayment(s)/claim(s) including, but not limited to what caused the overpaid benefits, how it was discovered and what action was taken;
3. DFS-100 Application(s) for Benefits (if appropriate) which cover(s) the time frame of the overpayment/claim;
4. All evidence used to establish the overpayment, i.e. DFS forms, POWER Request for Work Activity Expenditure, verification of work hours, employer statements, wage stubs, Child Care Billing Statements, death certificate, etc.;
5. Child Care Authorizations for the time frame of the overpayment;
6. First Notice of Overpayment for Child Care Recipient, all pages (C903);
7. Original 707 as this is a requirement for continued child care, unless this was an agency error; and,
8. If appropriate, copies of all decisions from any disqualifications, administrative hearings or legal actions.
D. See Combined Manual Section 2006 for more instructions and procedures for claims coded with the error cause code of “DE”.
E. See Appendix 6 for instructions on destruction of cases with overpayments before destroying inactive cases or any part of an active case.