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

(Revised 11/01/13 ML3384)

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IM 5323

 

 

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.  

 

Example:

  1. 20 year old single individual is approved for SNAP and informed to report if her income exceeds the 130% GIL for a household size of one. During the review period, the 20 year old moved in with mom. The 20 year old must include mom’s income in determining if her income exceeds the 130% GIL for a household size of one.

    The 20 year old reports the move to the worker. The worker must send the F419 for the information needed to add mom to the 20 year olds case. If the household responds, mom is added to the 20 year olds case. The worker must then send the F741 –Household Over Gross Income Limit and Eligible- Reporting Requirement (Ongoing Case) or F742 – Household Under Gross Income Limit Reporting Requirement (Ongoing Case), whichever is appropriate, informing the household of their new reporting requirement based on the increased household size.

    If the household fails to respond, the case continues until review.

  1. Boyfriend and girlfriend living in the same home apply for SNAP and are determined to be separate households and were approved for benefits. Since separate household status was established at the time of application, they do not need to include each other’s income in determining if their income exceeds the 130% GIL.

    During the review period, girlfriend reports they were married. The worker must send the F419 for the information needed to add boyfriend to girlfriend’s case. If the household responds, the boyfriend is added to the girlfriend’s case after allowing for advance notice to close the boyfriend’s case. The worker must then send the F741 or F742, whichever is appropriate, informing the household of their new reporting requirement based on the increased household size.

    If the household fails to respond, the cases continue until whichever household is required to complete the first review.

  2. 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.