495 Unintentional Program Violations

A claim for overissuance is considered an unintentional program violation claim if it was not caused intentionally, as defined in 106 CMR 367.525. All claims established shall be collected in accordance with 106 CMR 364.870: Unintentional Program Violation Claim Demand Letter (Request for Repayment). An overissuance claim of an unintentional program violation may be established due to either an inadvertent household error or an agency error that occurred no more than six years prior to the month in which the overissuance was discovered. (A) Inadvertent Household Error. A claim shall be considered to be an inadvertent household error claim if the overissuance was caused by a misunderstanding or unintended error on the part of the household. Inadvertent household error includes, but is not limited to, instances in which the household: (1) unintentionally failed to provide correct or complete information; (2) unintentionally failed to report a change in circumstances; (3) received benefits to which it was not entitled; or (4) received more benefits than it was entitled to receive, pending a Fair Hearing decision. (B) Agency Error. A claim shall be considered to be an agency error if the overissuance was caused by a Department action or failure to act. Department errors which result in a claim include, but are not limited to, instances where the Department: (1) failed to take prompt action on a reported change; (2) incorrectly computed the benefit level; (3) incorrectly issued duplicate SNAP benefits which the household did not request but subsequently transacted; (4) continued to provide benefits after the household's certification period had expired without redetermining eligibility or benefit level; or (5) failed to reduce the benefit level when the public assistance grant changed. (C) Non-claim Situations. A claim for overissuance shall not be established when an overissuance has solely occurred as a result of the Department's failure to ensure that the household signed the application form or completed a work registration form. (D) Calculating the Amount of an Unintentional Program Violation Claim. The amount of an overissuance claim due to an unintentional program violation is determined by calculating the difference between the amount of benefits actually received and the amount the household was entitled to receive during the time period at issue. If the household received excess benefits because it unintentionally failed to report a change in circumstances, the first month of overissuance shall be the month the change would have been effective had it been acted upon on time. If the Department did not act timely on a reported change, the first month of overissuance shall be the first month the change would have been effective if it were reported on time. In no event shall the Department determine the month the change would have been made effective to be more than two months from the month in which the change occurred. If a notice of adverse action was required, but not provided, for the purpose of calculating the claim, the Department shall assume the maximum advance notice period would have expired without the household's requesting a fair hearing. (E) Collecting Claims for Unintentional Program Violation. (1) Inadvertent Household Error. The Department shall initiate the collection of a claim due to an inadvertent household error by sending the household a claim demand letter and a repayment agreement, unless the household has already repaid the claim or the Department has documentation showing that no member of the household can be located. The claim demand letter shall contain the information provided in 106 CMR 364.870(A) through (E). The repayment agreement shall contain the information provided in 106 CMR 367.825(C)(1) through (4), (6), (7) and (9). The agreement shall also state that failure to return a completed and signed copy of the agreement within 20 days shall result in automatic benefit reduction. Renegotiation of the repayment agreement may be requested by the household member or the Department whenever there is a substantial change in circumstances. At no time shall an agreement be made which would recover less per month than could be collected through automatic benefit reduction. Any lost benefits shall be offset against a claim for overissuance. (2) Agency Error. The Department shall initiate the collection of a claim due to agency error by sending a claim demand letter and a repayment agreement, unless the household has already repaid the claim or the Department has documentation showing that no member of the household can be located. The claim demand letter shall contain the information provided in 106 CMR 364.870(A) through (E). The repayment agreement shall contain the information provided in 106 CMR 367.825(C)(1), (2), (4), (6) and (7). If the household fails to respond to the demand letter, additional demand letters may be sent. The Department may also pursue other collection actions against a household that fails to respond to a demand letter. (F) Compromising Claims. If the amount of the claim cannot be paid in full within three years without creating a financial hardship for the household, the Department may compromise the claim by reducing it to an amount that will allow the household to pay the claim within three years. The Department shall not compromise below the amount which could be collected through automatic benefit reduction ($10 or 10%, whichever is greater). (G) Failure to Make Payments. If a household has signed a repayment agreement for an overissuance due to inadvertent household error, and then fails to meet the payment schedule, the Department shall notify the household that unless payment is made or the agreement is renegotiated due to a change in circumstances, the next scheduled allotment shall be reduced by the greater of 10% of the allotment or $10. If a household requests renegotiation of its repayment agreement but the Department does not find that the household's circumstances have changed enough to warrant renegotiation, allotment reduction shall be initiated or continued, without further notice unless payment is made. (H) Suspending Collection. An unintentional program violation claim may be suspended if no collection action has been taken because the claim is collected through offset, or the claim is less than $125 or the minimum recovery threshold established by the Department, whichever is higher, unless the household is currently receiving SNAP benefits. If the claim is for an inadvertent household error, the household is no longer participating and at least one claim demand letter has been sent, further collection may be suspended, at the Department's discretion, when: (1) the household cannot now be located; or (2) the cost of further collection action is likely to exceed the amount that can be recovered. (I) Terminating Collection. A claim shall be determined uncollectible after three years in a suspended status. (J) Postponing Collection. Collection shall be postponed when the household is being referred for possible prosecution at an Administrative Disqualification Hearing, or a court of appropriate jurisdiction, on the same or related issues. Postponement shall also occur if a legal representative prosecuting the household advises in writing that collection action will prejudice the case. (K) Changes in Household Composition. Collection action shall be initiated against any or all of the adult members of a household at the time an overissuance occurred. Therefore, if a change in household composition occurs, the Department may pursue collection action against any household that has a member who was an adult member of the household that received the overissuance. The Department may also offset the amount of the claim against restored benefits owed to any household that contains a member who was an adult member of the original household at the time the overissuance occurred. The Department may not, under any circumstances, collect more than the amount of the claim. In pursuing claims, the Department may use any of the appropriate methods of collecting payments.