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FOOD AND NUTRITION SERVICES CERTIFICATION CLAIMS Agency Error (AE) Claims

6 Section 810 Change #3 2017 September 20, 2017 3. If the client is unable or unwilling to provide the required verification, calculate the overissuance using wage match or other readily available sources.

4. It is not possible to establish a claim if verification cannot be obtained from any source. Document and flag the certification record and claims file that there is an outstanding claim which cannot be established.

5. Do not terminate a case or deny future participation if the claim cannot be established due to the failure or refusal of a third party or client to cooperate.

6. Document the partially completed DSS-1682 as a suspected overissuance and the reason the claim has not been established. Unsubstantiate and close the referral in EPICS. Open a new referral if the verification becomes available later.

B. Client Failure/Refusal to Cooperate with the Investigator

If the client fails/refuses to provide verification or refuses to authorize a third party to release information, do not consider the household ineligible for the months when a suspected overissuance may have occurred. Use a DSS-8231, Request for Information, to request verification. Do not require the client to come into the agency or threaten any action to require the household to cooperate. Take the following actions:

1. Calculate the overissuance using information verified through any readily available source. For example, use wage match for unreported wages. If the client contests the use of wage match and verification is subsequently received, recalculate the claim using the verified information.

2. Do not establish a claim if verification cannot be obtained. Document and flag the certification record and document the claims file.

3. Document the partially completed DSS-1682 as a suspected overissuance and the reason the claim cannot be established. Close the referral as unsubstantiated in EPICS.

4. Open a new referral and establish the claim if the client subsequently cooperates.

810.05 CLIENT INTERVIEWS

A. Do not require a client under investigation to come into the agency to discuss the amount of the claim or the type of the claim. A client’s participation during an investigation is strictly voluntary. Refer to DSS-8230, Program Integrity Appointment Notice.

B. Schedule and conduct a home visit with the household, if appropriate. Mail a DSS-8230, Program Integrity Appointment Notice, three business days prior to a scheduled home visit. A client may refuse a home visit.

C. Continue the investigation if the client does not cooperate with the interview or home visit. Establish a claim without a client interview, if the client does not keep the appointment, and the evidence is clear and convincing to prove the overissuance.