Unclear or Insufficient Information to Make a Benefit Determination 430-05-67-15-20

(Revised 11/01/06 AMENDED ML3044)

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Whenever a worker receives unclear or insufficient information from a household and the worker is unable to determine the effect on the benefit, the worker must pursue clarification and verification of household circumstances using the following procedures:

  1. The worker must send Notice - F419 “Request for Verification” to the household clearly advising the household of the verification it must provide or the actions it must take to clarify its circumstances. The household must be allowed 10 days from the mailing date of F419 to respond and to clarify its circumstances either by telephone or by correspondence.
  2. If the household responds and provides sufficient verification within the 10-day period and it results in an increase in benefits, the worker must act on the reported change within 10 days and send the household the appropriate notice.
  3. If the household fails to provide verification within the 10-day period, the previously verified amount of the reported change is used and the benefit stays the same.

If there is no previously verified amount (i.e. household reports paying rent and previously had not), no change is made and the benefit stays the same.  

  1. If the household provides the verification at a later date and the change results in an increase in benefits, benefits are increased the month after receipt of the verification.

Example:

If a household reports an ongoing decrease in income on October 15, the worker must send notice F419 to the household.  If the household does not respond within 10 day of the mailing date, the reported and unverified change is not acted on when determining eligibility and level of benefits for November.  The benefit stays the same.  

On November 16, the household provides verification of the previously reported and unverified ongoing decrease in income.  When determining eligibility and level of benefits for December, the verified change is made as it results in an increase in benefits.  

  1. If the household responds and provides sufficient information/verification or provides sufficient information/verification at a later date and the change results in a decrease in benefits, the change must not be acted on until review.

Exception:

If the change meets the criteria to reduce benefits, the change must be acted on within 10 days from the date the change was reported and a 10 day advance notice must be sent.  If the change is reported in writing and signed by the household, a 10 day advance notice is not required.  Adequate notice is required.  

 

Example:

Ongoing SNAP/MA case.  Client is paid twice a month and provides only one pay stub from the base month or provides a pay stub from the base month and one pay stub from the processing month.  Year to date totals can be used.  The worker sends notice F419 requesting additional information, because we cannot determine the effect on the benefit.  If the household provides the second pay stub from the base month, the worker must determine if base month income results in an increase or decrease in benefits.  If base month income results in an increase in benefits, the income must be used.  If base month income results in a decrease in benefits, the income is not used.  The previously verified amount of income is used.  

If the household fails to provide the second pay stub from the base month, the previously verified amount of income is used.