2. GENERAL RULE:

Official source

A. A claim may be established against any household that has received more benefits than entitled. There are three classifications of claims:

(1) Agency - An overpayment which was the result of a Departmental mistake, or failure to act in a timely manner.

(2) Intentional - An overpayment which was the result of a household member intentionally violating a program regulation. This determination must be made by a hearing officer, a court, or a Waiver of Hearing signed by the member.

NOTE: A guilty verdict or a plea of guilty to a criminal charge based on the same conduct that satisfies the criteria for an intentional violation shall suffice to establish such a violation administratively. The amount of the overpayment and corresponding amount due to the Department shall be the amount specified in the letter of debt to the household, irrespective of any Court order of restitution.

(3) Inadvertent Household - An overpayment which was the result of a misunderstanding on the part of the household.

B. The Department shall not establish an overpayment when:

(1) The Department failed to ensure that a household fulfilled the following procedural requirements:

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2. GENERAL RULE:

Official source

A. A claim may be established against any household that has received more benefits than entitled. There are three classifications of claims:

(1) Agency - An overpayment which was the result of a Departmental mistake, or failure to act in a timely manner.

(2) Intentional - An overpayment which was the result of a household member intentionally violating a program regulation. This determination must be made by a hearing officer, a court, or a Waiver of Hearing signed by the member.

NOTE: A guilty verdict or a plea of guilty to a criminal charge based on the same conduct that satisfies the criteria for an intentional violation shall suffice to establish such a violation administratively. The amount of the overpayment and corresponding amount due to the Department shall be the amount specified in the letter of debt to the household, irrespective of any Court order of restitution.

(3) Inadvertent Household - An overpayment which was the result of a misunderstanding on the part of the household.

B. The Department shall not establish an overpayment when:

(1) The Department failed to ensure that a household fulfilled the following procedural requirements:

(a)Sign the application form; or#

(a) Sign the application form; or

(b)Complete a work referral form.#

(b) Complete a work referral form.

(2) A household was not required to report a change which results in reduced benefits or ineligibility for benefits.

(3) The overpayment is caused by an Agency or Inadvertent Household error, has a dollar value of $500 or less as determined per Paragraph 6(A) below, and the household is not participating when the over issuance is calculated.

(4) The overpayment is caused by an Agency or Inadvertent Household error, has a dollar value of $200 or less as determined per Paragraph 6(A) below, and the household is participating when the over issuance is calculated, or

(5) The overpayment is caused by an Agency or Inadvertent Household error that occurred on or after March 1, 2020 and during the Federal Public Health Emergency related to 2019-nCoV declared by Secretary Azar on January 31, 2020 which ended May 11, 2023.

EXCEPTION: All overpayments resulting from either a Quality Control review or trafficking must be established regardless of the amount, cause, or timing. (See definition of trafficking in Section 999-1.)

NOTE: In situations where there are overpayments for both State funded benefits and Federally funded benefits, the overpayment attributable to the Federally funded benefits are collected first.