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FOOD AND NUTRITION SERVICES CERTIFICATION CLAIMS ____________________________________________________________________________________

1 Section 800 Change #1-2017 April 1, 2017

FNS 800 Claims Change #1-2017 April 1, 2017

Claims begin with referrals from any source that alleges a Food and Nutrition Services household has received or used benefits inappropriately, or has provided questionable information during the application/recertification process or when reporting a change. The Date of Discovery for all types of referrals is the date Program Integrity determines there is an actual FNS overissuance through completing a DSS-1682, Report of Erroneous Overissuance or determines there is not a FNS overissuance and unsubstantiates the referral in EPICS. The five basic types of referrals are defined below.

800.01 FRONT END REFERRALS Front End Referrals are used when information provided by the applicant is questionable or conflicting, and eligibility cannot be determined. Front End Referrals are referrals made after the application is filed but before an application is approved or denied. The caseworker processing the application should attempt to resolve the eligibility factor using all available sources before referring a case for a Front End. The Investigator must act on the referral to resolve the eligibility factor, and provide a decision to the caseworker within ten (10) calendar days. Do not delay processing an application unless a DSS-8650, Notice of Information Needed to Complete your FNS, is pending. See Section 840 for policy regarding Front End Investigations. Enter Front End Referrals in EPICS with a referral type code of “F”. Front End referrals are the only referrals types that can be opened in NC FAST.

800.02 REGULAR REFERRALS Regular referrals apply to both active and terminated cases. The referral source can be a caseworker, third party source, or automated match. Regular referrals usually result in an Agency Error (AE) or an Inadvertent Household Error (IHE) claim because they do not appear to involve a false statement by the applicant. However, a regular referral may result in an Intentional Program Violation (IPV) claim once the investigation is completed. Establish claims or refer for an Administrative Disqualification Hearing (ADH) or criminal prosecution within 180 days of the Date of Discovery. Enter regular referrals in EPICS with a referral type code of “R”.

800.03 SUSPECTED INTENTIONAL PROGRAM VIOLATION REFERRALS Suspected IPV referrals apply to both active and terminated cases. The referral source can be a caseworker, third party source, or automated match. Generate a suspected IPV referral based on the belief that a false statement was made at application or recertification or when reporting a change. Establish a claim or refer for an Administrative Disqualification Hearing (ADH) or criminal prosecution within 180 days of the Date of Discovery. Enter suspected IPV referrals with a referral type code of “S” (except IPV referrals suspected of trafficking. See section 800.05 for trafficking referrals). 800.04 PROJECT RECALL REFERRALS Project Recall referrals are generated from a Project Recall verification. Counties are provided monthly listings of applications approved two months prior to the current month. Use this list to randomly select cases and check for changes that may have occurred since the application. Counties are not required to participate in Project Recall. Enter Project Recall referrals in EPICS with a referral type of “P”.