FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner

Transcription

1 FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures and Training Lisa C. Fitzpatrick, Assistant Deputy Commissioner Office of Procedures POLICY BULLETIN #07-87-OPE REVISION TO CONFERENCE AND FAIR HEARING EVIDENCE PACKET PREPARATION DESK AID (W-206C) Date: July 16, 2007 This procedure can now be accessed on the FIAweb. Subtopic(s): Fair Hearing The purpose of this policy bulletin is to inform all Job Center staff that the Conference and Fair Hearing Evidence Packet Preparation Desk Aid (W-206C) is being revised to include form replacements and changes in required documents and program names. This policy bulletin serves as information for all other staff. The form changes are as follows: See PD #05-42-SYS See PB #07-31-OPE W-145N and W-145P were made obsolete. Application/Job Profile (W-680B) was made obsolete and has been replaced by the Statewide Common Application (LDSS-2921). Request for Emergency Assistance for an Active PA Case (W-145N) and Notice of Acceptance/Denial of Request/Application for Emergency Housing Aid (W-145P) were made obsolete and have been replaced by the Request for Additional Allowance or Change (W-137A) and Action Taken on Your Request for Emergency Assistance or Additional Allowance (For Participants Only) (W-137B). Reference made to the Personal Roads for Individuals Development to Employment (PRIDE) program has been removed as was Section A. FTC with Back to Work PRIDE Vendor under the issue of Infractions, as the program no longer exists. The reference made to TAD Referral Letter (LDSS-3517) under Documents Required for Part G. Separate Food Stamps Determination for Ineligible for Public Assistance was removed, as it was an incorrect statement. HAVE QUESTIONS ABOUT THIS PROCEDURE? Call then press 2 at the prompt followed by 765 or send an to FIA Call Center Distribution: X

2 PB #07-87-OPE Notice of Intent to Change Food Stamp Benefits (LDSS-3620, LDSS-3621) under Documents is now listed as two separate forms: Notice of Intent to Change Food Stamp Benefits (Timely and Adequate) (LDSS-3620 NYC) Notice of Intent to Change Food Stamp Benefits (Adequate Only) (LDSS-3621) See PB #06-74-OPE Important Notice to All Food Stamp Recipients (W-138XX) has been made obsolete and replaced by the Food Stamp Change Report form (LDSS-3151). References to Food Stamp Budget Calculation (WINR0154) were replaced by Food Stamp Budget Calculation Report for NPA and NPA-SSI Cases (WINR0153). References to HSS/WeCARE were changed to WeCARE. References to SAP or ESP/SAP were changed to Back-to- Work. Center Directors must ensure that all previous versions of the W-206C are removed from circulation and recycled. Effective Immediately Please use Print on Demand to obtain copies of forms. Attachments: W-206C Conference and Fair Hearing Evidence Packet Preparation Desk Aid (Rev. 07/16/07) FIA Policy, Procedures and Training 2 Office of Procedures

3 Form W-206C (page 1) Denial For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. Failure to comply with eligibility process Failure to return requested eligibility documentation Denial of special grants Excess income/resources Ineligible for other reasons Withdrawal A. Failure to Report/Failure to Comply (FTR/FTC) with Eligibility Process Statewide Common Application (LDSS-2921), Action Taken on Your Application (LDSS-4013A NYC, LDSS-4013B NYC) Documentation Requirements (W-113K) Case Notes/History Sheet (W-25) Pending Actions and Outstanding Items (NQCS07) screen Pending Transaction Control Detail List (NQCS7A) screen Mandatory Dispute Resolution (MDR) Summary (W-204R) Specific Required Information 1. Failure to Keep BEV Appointment Appointment Notice BEV Results 2. FTR/FTC WeCARE Notice of Intent (NOI)/Client Notice System (CNS) Medical Provider Appointment (W-538C), Employability Plan WeCARE Wellness Plan WeCARE Medical Report (signed acknowledgement/goals) Notice of Termination 3. FTC with AFIS Requirements Finger Imaging Notice (W-519) Finger Imaging Report Routing Slip (W-519C) 4. Excess Income/Resources (Unreported by applicant; appearing on a computer match) B. FTC with Employment FTR/FTC Job Search/Back-to-Work Vendor External Clearance Report Computer match, NADA book value, life insurance policies Pay stubs/award letters/titles/loans and stock information Budget (saved and current) Other documentation of earned/unearned income or resources TALX printout NOI Employability Plan Notification of Temporary Assistance Work Requirements Determination (LDSS-4005) Assignment Information Summary (W-500G), Conciliation Notification (W-532A, W-532B, W-532C) Assignment Inquiry screen, Attendance/Payment Inquiry Screen (100A)/ POS/ POS/ Selection 13 (MAPPER) Web Coins/ / POS// POS/ Web Coins/ / (100A)/

4 Form W-206C (page 2) Budget Reductions A. FTR/FTC Office of Child Support Enforcement (OCSE) Case Management Closings A. Face-to-Face Recertifications 1. FTR 2. FTC B. Whereabouts Unknown C. Unearned Income For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. Cost of Living Allowance (COLA) Increase (Yearly Mass Re-budgeting for SSI Recipients) Appointment Notice, case notes NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC) Notice of Recertification Appointment (W-908T) All Change Actions Screen (NQCS6A) Rescheduled FFR (W-908CC) Activity Inquiry Screen, case notes/w-25, Recertification Application (LDSS-3174) FFR Deferral Appointment Letter (W-113K, W-908VV) Notice to Report to Job Center (M-3g) All Change Actions Screen (NQCS6A), FTR/FTC, case notes/w-25 NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC, LDSS-4015A NYC, LDSS-4015B NYC) Undelivered mail (envelope available) Address History screens (1 and 6) Benefits Issuance screen (to show benefits not redeemed) Supplemental Security Income (SSI [SDX Screen]) Social Security Administration (SSA [RFI Screen]) Unemployment Insurance Benefit (UIB [RFI Screen]) Computer match/income Clearance Program (ICP)/Resource File Integration (RFI), SSI/SSD/UIB award letter or printout Budget (saved and current) NOI to Change Benefits: NYC PA COLA (yearly proration notice) NOI to Reduce FS Benefits (COLA Increase [Mass] Notice) SSI (SDX and RFI Screens) Web Coins///POS /HRA Viewe Web Coins// / / (100A) Web Coins// /Director's Office Web Coins/ / / / / Web Coins/ HRA intranet

5 Form W-206C (page 3) Closings (continued) D. Earned Income For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. E. Client's Request for Additional Allowance F. WeCARE 2 FTR WeCARE Initial/Return Appointment 2 FTC WeCARE Wellness Rehabilitation Plan G. Finger Imaging H. Excess Income/Resources (unreported by participant; appearing on a computer match) NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC, LDSS-4015A NYC, LDSS-4015B NYC) FIA-3A/pay stubs Letter to Past/Present Employer (W-532) or documentation that W-532 mailed, verification from vendor (if applicable) Budget (saved and current) Computer match Declaration of Employment (W-575T) TALX printout Client Request Control Card (W-111F) Request for Additional Allowance or a Change in Grant (W-137A) Action Taken on Your Request For Emergency Assistance or Additional Assistance (Participants Only) (W-137B) Medical Provider Appointment (W-538C) Employability Plan WeCARE Wellness Plan, specific information of noncompliance WeCARE Medical Report (signed acknowledgement/goals) Notice of Termination Finger Imaging Notice (W-519) Finger Imaging Report Routing Slip (W-519C) and attachments Notice of Intent to Reduce or Discontinue Benefits (LDSS-4015 NYC, LDSS-4016 NYC) External Clearance Report/budget (saved and current) Computer match, NADA book value, life insurance policies Pay stubs/award letters/titles/loans and stock information Other documentation of earned/unearned income or resources Web Coins// / POS/ / Web Coins/ ( WeCare Medical Report) Web Coins/ / (WeCare Medical Report) (WeCare Medical Report) POS/ POS//

6 Form W-206C (page 4) For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. Reductions/Sanctions A. Earned Income B. Unearned Income NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC, LDSS-4015A NYC, LDSS-4015B NYC) FIA-3A/pay stubs Letter to Past/Present Employer (W-532) or documentation the W-532 was mailed, verification from vendor (if applicable) budget (saved and current) Computer match/icp/rfi TALX printout SSI award letter SSA/RSDI (RFI or award letter) UIB award letter Budget (saved and current) Web Coins// / / Web Coins/ / / /

7 Form W-206C (page 5) For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. Infractions (Infraction dates must be consistent across all Agency documents) A. Contesting Employability Notification of Temporary Assistance Work Requirements Determination (LDSS-4005) Employability Plan / 1. Medical Exemption WeCARE Medical report 2. School/Training FIA School/Training Enrollment Letter (W-700D) 3. Needed at Home Family Care Assessment (W-582A) Proof of child's school attendance or Department of Education registration for home schooling B. POISED Appointment letter 1. FTR Call-In Appointment Conciliation Notification (W-532A, W-532B, W-532C) Referral Activity Inquiry Screen 2 FTC Attendance roster Termination roster Conciliation Notification (W-532A, W-532B, W-532C) Assignment Inquiry screen Attendance/Payment Inquiry screens C. SASC Appointment letter 1. FTR Initial Appointment Address history 2 FTR Program Referral to program Work Assessment form Participant's Rights and Responsibilities (M-75r) Web Coins/ (100A)/ Web Coins/ / (100A)/ /POISED Liaison Web Coins/ / (100A)/ Web Coins/ (100A)/ /

8 Form W-206C (page 6) Infractions (continued) C. SASC (continued) For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. 3. FTC Outpatient Program 4. FTR CASAC D. RTSC Center FTC CASAC 2. FTR Face-to-Face Recertification 3. FTC-Mandated Residential Treatment Program (RTP) Referral to program Participant s Rights and Responsibilities (M-75r) Work Assessment form Assignment Inquiry Site Inquiry Referral to Residential Treatment Program Participant's Rights and Responsibilities (M-75r) Work Assessment form /FTR/FTC Referral to Residential Treatment Program Participant's Rights and Responsibilities (M-75r) Work Assessment form Notice of Recertification Appointment (W-908T) Address history /FTR/FTC Referral to Residential Treatment Program Participant's Rights and Responsibilities (M-75r) Work Assessment form Address History screen (NQCS15) Site Inquiry screen Assignment Inquiry screen Web Coins/ (100A)/ / Web Coins/ (100A)/ / Web Coins/ (100A) Web Coins/ POS/ Web Coins/ (100A)/

9 Form W-206C (page 7) For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. Infractions (continued) D. RTSC Center 52 (continued) 4. Earned Income 5. Inadequacy Personal Needs Allowance E. Recoupment 1. Overpayment (agency error) Agency issued benefits after closing, income reported Agency failed to budget 2. Concealed Income 3. Contested Recoupment (recoupment of aid to continue) NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC, LDSS-4015A NYC, LDSS-4015B NYC) FIA-3A/pay stubs Letter to Past/Present Employer (W-532) Budget (saved and current) Computer match/rfi Declaration of Employment (W-575T) TALX printout /FTR/FTC Assignment Inquiry screen Site Inquiry screen Administrative Directive 91 ADM-44 Required for All Recoupments NOI Recoupment history/recoupment detail Recoupment summary Benefits issued (current/archived) Budget (saved/current) Employer information ICP packet (cintrak sheet) FIA-3A/pay stubs Client acknowledgement of change in budget Computer Match Report Pay stubs Statewide Common Application (LDSS-2921) or TALX printout RFI screens Fair Hearing decision Date of infraction WebCoins//POS/HRA/Viewer / POS/ / Intranet-NYS Human Services Center Files/ Center Files/ Center Files/ / Center Files/ Center Files/ / (100A)/ Web Coins FHIS (Fair Hearing Information System)

10 Form W-206C (page 8) For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. Infractions (continued) E. Recoupment (continued) 4. Utility 5. Shelter Duplication F. Separate Food Stamps Determination C. Applicant Withdrawal W-137A, W-137B, W-147X Utility shut-off notice, breakdown of rent arrears Agreement to Repay (M-858 series) Restriction screen (24) Request for Emergency Assistance for an Active PA case (W-137A, W-137B) Request for Advance Payment to Prevent Eviction (W-637B) Dispossess: 72-hour eviction notice Landlord letter with breakdown of rent arrears Stale-dated checks Statewide Common Application (LDSS-2921) Notification of Application Withdrawal (M-3mm) Action Taken on Your Food Stamp Case (LDSS-3152) /POS D. Ineligible for Public Assistance Action Taken on Your Application (LDSS-4013A NYC, LDSS-4013B NYC) Control of Assignments/Referrals Card (W-708) Action Taken on Your Food Stamp Case (LDSS-3152) Budget Entry Supervisory Summary Report (WINR0027) POS/

11 Form W-206C (page 9) For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. (continued) Other Issues Inadequacy A. General Inadequacy 1. Failure to Add Household Member 2. Failure to Remove Household Member B. Inadequacy of Special Grants FFR one (1) year or less (burden of proof is on client) Statewide Common Application (LDSS-2921) (one [1] year or less) W-137A, W-137B PA and FS budget calculations Relevant benefits screens Written statement indicating changes in the household W-137A, W-137B (Documents required for all Special Inadequacies) Request for Additional Allowance or a Change in Grant (W-137A) Notice of Acceptance/Denial (W-137B) LDSS-4013A NYC, LDSS-4013B NYC Client Request Control Card (W-111F) Statewide Common Application (LDSS-2921) 1. Pregnancy Allowance Doctor's verification of pregnancy (EDC letter) 2. Restaurant Allowance 3. Storage Letter from shelter (no cooking facilities) Letter from landlord (inoperable stove, refrigerator, etc.) Three (3) estimates, bill from storage company, Benefit Issuance Printout (100A)/ 4. Broker's Fee Lease, letter from broker 5. Furniture Allowance Fire/natural disaster, shelter verification 6. Clothing Allowance Natural disaster data (letter from Red Cross/fire department)

12 Form W-206C (page 10) Non-Public Assistance Food Stamp Cases For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. FTR/FTC Face-to-Face Recertification Excess or Increased Income/Resources Decreased Needs Adequacy Issues Failure to Provide Verification 1. FTC/FTR Face-to-Face Recertification Notice of Intent to change Food Stamps Benefits (Timely and Adequate) (LDSS-3620 NYC). Notice of Intent to change Food Stamp Benefits (Adequate Only) (LDSS-3621) or CNS notice (closing or reduction only) Food Stamp Change Report Form (LDSS-3151) FS Budget Calculation (WINR0153) Budget Entry Supervisor Summary Report (WINR0027) Turnaround Document (TAD) (LDSS-3517) FS Recoupment Suffix Summary (NQCS9R) Food Stamp Issuance Screen Printout (NQCS5C) Appointment letter Annotated (WINR076) CNS Notice Notice of Outstanding Required Documentation (W-120D) Documentation Requirements and/or Assessment Follow-Up (W-113K) LDSS-3152 W-25 Documentation Receipt (EXP-76R) Case Files//Web Coins Case Files/ Case Files/ / Case Files/ Case Files/ Case Files/ Center Files/ WebCoins Case Files/ Case Files/ Case Files/ Case Files/ Case Files/

13 Form W-206C (page 11) For conferences, relevant Screens (22, 04, 03, 01, 06, Budget) must be reviewed. 2. Excess or Increased Income/Resources 3. Decreased Needs 4. Adequacy Issues 5. Failure to Provide Verification Food Stamps Benefits Application/Recertification (LDSS-4826), Action Taken on your FS case (LDSS-3152) Pay stubs, Letter to Past and Present Employer (W-532) Bank statements, award letters Budget Entry Supervisory Summary Report (WINR0027) Food Stamp Budget Calculation WINR0153 (For NPA and NPA-SSI Cases) Notice of Intent to Change Food Stamp Benefits (LDSS-3620), Shortened Food Stamp Application (LDSS-3621) W-25 Food Stamp Recertification History Sheet (W-132X) TALX Printout (Where Applicable) LDSS-4826 LDSS-3620 NYC LDSS-3621 NYC WINR0027, WINR0153 Food Stamp Eligibility Determination History Sheet (W-132A) Food Stamp Recertification History Sheet ( W-132X) LDSS-4826, CNS Pay stub, W-532 W-132A, W-132X Award letters WINR0027, WINR0153 LDSS-4826, LDSS-3152, CNS Notice of Outstanding Required Documentation (W-120D) EXP-76R History Sheet (W-25) Case Files//WebCoins Case Files/ Case Files/ Case Files/ Case Files/ Case Files/ Case Files/ Case Files/ Case Files//WebCoins Case Files/ Case Files/ Case Files/ Case Files//WebCoins Case Files/ Case Files/ Case Files/ Case Files/ Case Files//WebCoins Case Files/ Case Files/ Case Files/