Page 125

FOOD STAMP HANDBOOK Handbook FORMS _AND INSTRUCTIONS __ 63-1230 (Cont)

63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230

DFA 842 (6/81) (Instructions Revised 3/84)

11. Summary of Food Stamp Overissuance

Compiete this section for all claims where overissuances occurred within the 12 months prior to the date of discovery. Space is provided for 14 months to include the current month's issuance if benefits have already been issued at the time the worksheet is completed, and to include the following month's issuance if sufficient time does not exist to provide a timely notice of benefit reduction. |f potential intentional program violation and only a few months fall within the 12-month period prior to the date of discovery include only those months in this section. Record the remaining months on the second page (Item 14)

Issuance Month and Year

Enter the month and year of all overissuances which occurred within the 12 months prior to the date of discovery. Enter the date for the current and following month's issuances, if appropriate. Actual Basis for Issuance — HH Size

Enter the household size used in the original benefit computation. — Adjusted Income

Enter the net adjusted income from the original benefit computation.

— Allotment Enter the allotment actually received by the household for each overissuance month. Correct Basis for Issuance — HH Size Enter the correct household size for each overissuance month. -— Adjusted Income Enter the correct net adjusted income for each overissuance month. — Allotment Enter the correct aliotment the household should have received.

issuance Verification

Use of this section to verify issuance of the benefits covered by the claim is a county option. lf this section is not used for this purpose, verification of issuance must be documented in

some other manner. For verification of ATP usage, the DFA 332.1, Verification of Food Stamp ATP Usage, may be used,