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VIRGINIA DEPARTMENT OF SOCIAL SERVICES D-SNAP

10/24 VOLUME V, PART XX, APPENDIX I PAGE 14

Internal Action and Vault EBT Card Authorization For Disaster Benefits

Form Number - 032-03-0664 (Note: This form will only be used if issuance must be performed manually. In all other instances, the internal action form will be generated through the Web-based disaster eligibility system.)

Purpose of Form – This form documents that the BPS authorizes the Issuance Worker to set up an EBT account and post benefits. It also documents that the household received its EBT card.

Use of Form - The BPS completes the top portion of the form to authorize the Issuance Unit to prepare and issue a vault card to a Disaster benefit household. The Issuance and Administrative Unit completes the bottom portion of the form to document that an account was set up and benefits were posted. The applicant or the applicant’s authorized representative must sign the form to acknowledge receipt of the vault card.

The agency must also use the internal action form to document repayment of a claim with funds in an EBT account or to debit an account for an administrative error.

Number of Copies - One.

Disposition of Form - The form is retained in the disaster case file for a minimum of three years.

Instructions for Preparation of Form - The BPS or Supervisor must complete the identifying case and unit information. For approved disaster applications, the BPS must enter the amount of disaster benefits authorized, the household size, the Social Security number and date of birth of the case name, and the household’s address.

The Eligibility Supervisor or designee must complete Section II to authorize crediting the card replacement fee back to the household's EBT account. The Eligibility Supervisor must also complete Section III to debit benefits from an account that were erroneously deposited because of an administrative error.

Generally, the Issuance Unit should prepare a vault card for the household on the same day the form is received. The Issuance Worker with either Update 1 or Update 2 role in EPPIC issues the vault card after the case had been transmitted to EPPIC. The Issuance Worker must record identity verification before releasing the vault card to the cardholder and secure the signature of the applicant or the applicant’s authorized representative on the form.

The Issuance Unit must destroy the card after five business days if the card is not picked up by the applicant or the authorized representative. The Issuance Worker must note the date of the destruction of the card on the form.

The supervisor of the Issuance or Administrative Unit must complete the section to credit the card replacement fee back to the household's EBT account.

The Issuance or Administrative Worker or Supervisor must sign and date the form.

TRANSMITTAL #35