1000 Administration

1320 Simplified Eligibility And Verification

1321 Simplified Eligibility Determination - Simplified eligibility as adopted by the State is a system by which the agency accepts the individual's statement as the basis of eligibility. For some factors of eligibility, additional information will have to be obtained. In addition, federal rules of the Food Assistance Program mandate that certain items be verified for food assistance purposes. These polices are discussed in 1322 . For ease of administration, some of these verification requirements have been adopted for the cash and child care programs.

The agency shall:

Use, to the greatest extent possible, the information on the application/redetermination form, as provided by the individual applicant/recipient, for purposes of determining eligibility and extent of entitlement.

Carefully review the form for completeness, clarity, consistency, and lack of error or questionable statement.

Give the applicant/recipient the opportunity to present additional clarification when information on the form is incomplete, unclear, or inconsistent, or where other circumstances in the particular case indicate to a prudent person that further inquiry needs to be made. Negative action as a result of failure to provide the information can be taken only when written notice was given allowing at least 10 calendar days from the date the notice is initiated to return the information.

Consider additional information from agency records.

Advise the applicant/recipient when it is necessary for the agency to go to other sources, and when necessary obtain his consent on the information release form. If he does not consent to the necessary contacts, it may not be possible to determine that initial or continuing eligibility exists. Each applicant and recipient gives consent to a full field investigation when he signs the application/ redetermination form, but a signed informational release form may be necessary to obtain the needed information. (See 1212.4 .)

Consider verification/information received by 5:00 pm (or closing time) on a business day as received that day. Any verification/information received (for example in a drop box) after 5:00 pm (or closing time) on a weekday, holiday or weekend will be considered received the next business day.

1321.1 Sources of Verification

Documentary Evidence - Documentary evidence shall be used as the primary source of verification. Documentary evidence consists of a written confirmation of a household's circumstances. Examples are wage stubs, rent receipts, utility bills, medical reimbursement statements, and, for Social Security numbers, such evidence as BENDEX printouts, Social Security cards, or any official document containing the Social Security number.

Although documentary evidence shall be the primary source of verification, acceptable verification shall not be limited to any single type of document and may be obtained through the household or other sources.

Alternate sources of verification, such as collateral contacts and/or home visits, shall be used whenever documentary evidence cannot be obtained.

Collateral Contacts - A collateral contact is a verbal confirmation of a household's circumstances made by a person outside of the household. The collateral contact may be made either in person, by mail or over the telephone. The acceptability of a collateral contact shall not be restricted to a particular individual but may be anyone who can be expected to give an accurate third party verification of the household's statements. Examples of acceptable collateral contacts are employers, landlords, social service agencies, migrant service agencies, and neighbors of the household. When talking with collateral contacts, staff should disclose only the information that is absolutely necessary to get the information being sought. Staff should avoid disclosing that the household has applied for benefits, nor should they disclose any information supplied by the household, especially information that is protected per 1223 , or suggest that the household is suspected of wrong doing. This applies to collateral contacts other than those where there is a need to share full information such as the Social Security Administration. See 1222 .

Home Visits - Home visits, for the purpose of establishing eligibility, shall be used as verification only if documentary evidence cannot be obtained. For purposes of the Food Assistance Program, a home visit must be scheduled in advance with the household. Staff must document the need for a home visit in the case record.

An unscheduled home visit for food assistance purposes can only be conducted when there is substantial documentary or collateral evidence that a household is or is attempting to commit fraud, and the unscheduled home visit is a part of a fraud investigation.

Failure of a client to cooperate with or consent to a scheduled or unscheduled home visit shall not directly affect eligibility, and no case shall be closed or denied because an applicant/ recipient refuses to grant admittance to his/her home or cooperate during a home visit. If a client refuses to cooperate with or consent to a home visit, a request for information shall be sent to the client. If the client fails to provide adequate verification as requested, then the case may be closed or the application denied, if that is the appropriate action based on the type of information that was not provided. See item (4) below.

NOTE: Home visits may be utilized with TANF work program participants in situations where a personal contact is appropriate and not achievable by other methods. These home visits may be scheduled or unscheduled.

Discrepancies - Where information from another source contradicts statements made by the household, the household shall be afforded a reasonable opportunity to resolve the discrepancy prior to an eligibility determination. Information needed to resolve the discrepancy shall be requested from the household, however, if the household fails to provide the necessary information, staff may elect to verify the information directly. Households are to be given 10 days to provide necessary verification. If the client does not or refuses to provide adequate verification to resolve the discrepancy, the case may then be closed or the application denied if that is the appropriate case action.

1321.2 Responsibility for Obtaining Verification - The household has the primary responsibility for providing documentary evidence to support its statements and to resolve any questionable information. Households may supply documentary evidence in person, by mail, or by an authorized or personal representative. Any reasonable documentary evidence provided by the household shall be accepted by the local office. The local office shall be primarily concerned with how adequately the verification proves the statements on the application. If it would be difficult or impossible for the household to obtain documentary evidence in a timely manner, the worker shall offer assistance to the household in obtaining documentary evidence at the interview and/or send a notice which includes the offer of assistance to all households.

The household shall not be held responsible when a person outside of the household fails to cooperate with a request for verification. ( NOTE: Individuals in the household identified as non-household members under 4212.1 and individuals identified as excluded or disqualified per 4212.2 or 4212.3 shall not be considered as persons outside of the household.)

1321.3 Documentation - Case files must contain documentation to support the determination to approve or deny program benefits. Documentation means that a written statement regarding the type of verification and a summary of the information obtained has been entered in the case record. Such statements must be in sufficient detail so that a reviewer would be able to determine the reasonableness of the determination. For example, when income is verified by the presentation of pay stubs, the gross amount of income on each pay stub, and the frequency of receipt of income is included on a copy of the pay stub in the case record or is recorded by the worker elsewhere in the case file.

Where verification was required to resolve questionable information, the worker shall document why the information was considered questionable and how the questionable information was resolved. The worker shall also document why any alternate sources of verification were needed and, if a collateral contact was rejected, the case file shall contain documentation of why the collateral contact was rejected and an alternate chosen.

The physical address of a participant in the Safe At Home (see Section 1723 ) program shall be obtained for the purposes of determining eligibility and benefit level but will not be recorded or documented in the case log or within the agency. To ensure the address is protected, only the Safe at Home mailing address will be entered in KEES. The county of residence will be entered in KEES in order to issue correct benefits and for a proper managed care assignment. Staff will note in the case file that the client is a Safe At Home participant.