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Page | 314 C. Claim Documentation

The DSS-EA-894, Overpayment Report, along with all supporting documents, must be filed in Section 5 of the case record. Supporting documents are the documents (e.g. wage stubs, bank letters, rent receipts) used to establish the claim amount.

The DSS-EA-894 and supporting documents must be retained in the case file for three years from the date the overpayment was paid in full, compromised to zero by ORFI, or terminated. Claim documents should not be purged from active records until 3 years after ORFI has terminated the claim.

19210 SITUATIONS NOT RESULTING IN AN OVERPAYMENT REPORT

An overpayment report will not be filed when the overpayment: 1. Was located more than 12 months after it occurred and intentional program violation (IPV) is not suspected. 2. Occurred because the household otherwise was eligible, but the Specialist failed to ensure that the household's application form was signed, that a current work registration form was completed, or that the household was certified in the correct county. 3. When a categorically eligible household is later found ineligible for TANF or SSI because of excessive resources (categorical eligibility cannot be rescinded retroactively).

19220 CLAIM TYPES

There are three types of claims: 1. Agency Error (AER) 2. Inadvertent Household Error (IHE) 3. Suspected program violation/intentional program violation errors (SPV/IPV)

The procedures to be followed for each claim type differ. The type of claim determines what procedures are followed. Each claim summary on the overpayment report (DSS-EA-894) must support how the claim type was determined.

19221 AGENCY ERRORS (AER)

An overpayment will be classified as an agency error claim when the agency’s action/failure to act, incorrect policy/procedure, and/or explanation of reporting requirements caused the overpayment.

The overpayment for an agency error will be calculated and a SPEC-C-RECO & DSS-EA-894 will be completed and sent to the Office of Recoveries and Fraud Investigations (ORFI). ORFI will complete the claim process and will send a letter to households indicating that an agency error occurred but due to current policies the claim will be paid by the State of South Dakota.

If the household is still participating in SNAP at the time the AER is discovered, overpayments under $250 will not be pursued by ORFI. The Spec-C-Reco & RE-894 must still be completed by the Benefits Specialist as ORFI still must track these errors. The Benefits Specialist will narrate on the case that an Agency Error occurred. Additionally, If the household is no longer participating in SNAP at the time the AER is discovered, overpayments under $500 will not be pursued by ORFI. The Example: Agency Error: The Specialist transposed gross wage amounts when entering on ACCESS (entered $250, but actual gross was $520). The overpayment was caused by DSS; thus, the claim is treated as an agency error claim.