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EXAMPLES: SIPV – Employment verification form completed by Wal-Mart showing a hire date of January 9, 2014, a termination date of April 16, 2014, first check received January 17, 2014, last check received April 25, 2014 and gross wages for the weeks of January 17, 2015 thru April 25, 2014. IHE - Copy of annual bonus check received in December. AE - Ms. Jane Doe reported on August 5, 2014 that her son, John was leaving her home to go live with his father. This was documented in the case record, but action was not taken by the county. CLIENT'S STATEMENT AND SUPPORTING EVIDENCE: An explanation of the error that caused a claim to be needed. The county must be very specific in describing the error, justifying the error type and listing all pertinent information including the client=s statement or explanation or the worker=s attempts to contact the client. See the examples below for the specific information that is to be included, noting that the IHE and SIPV claims require a client=s statement. EXAMPLE: SIPV - Be very specific. Document the dates of the MDHS-EA-900 prior to the claim, followed by all of the 900’s during the claim period, including whose signature appears on each form. An explanation should be made about how long the case has been active and any other information the county has to back up the claim. This part of the narrative should back up the county=s belief that the assistance unit is suspected of an Intentional Program Violation. For example: Ms. Jane Doe failed to report that she had accepted employment at Wal-Mart. Ms. Jane Doe signed the MDHS-EA-900 at application on January 3, 2013. Ms. Jane Doe signed the MDHS-EA- 900 again at redetermination on December 18, 2013. Client's Statement: If the county did not discuss the claim with the assistance unit, a MAVS Request for Information should be mailed. The county must explain in the notice that a claim is being worked and ask for a statement explaining why they did not timely report the information being used in the claim. The county will also need to explain who will be responsible for the repayment. The statement that is given by the assistance unit must be included in this section of the claim. AE - This claim is being worked as an agency error because Ms. Jane Doe reported timely that her son, John, was moving out of her home and in with his father. However, the county failed to act on this information and remove John from the case. IHE - At application, Ms. Jane Doe provided wage verification without including the annual holiday bonus received each December.

Volume III | Chapter 14