(A) The county
agency shall establish and collect a claim against any assistance group that
trafficked benefits or received more
food
assistance
supplemental nutrition assistance
program (SNAP) benefits than it was entitled to receive. A recipient
claim is an amount owed because of overpaid benefits or benefits that are
trafficked. Trafficking is defined in paragraph (J) of rule
5101:4-8-17
of the Administrative Code. Prompt corrective action to prevent further
overpayment is required. A
food assistance
SNAP claim is a federal debt subject to this
rule and other regulations governing federal debts. This rule describes the
three types of claims and the procedures the county agency shall follow when
handling these claims.
(B) Who is
responsible for paying a claim?
(1) Each
person who was an adult member of the assistance group when the overpayment or
trafficking occurred. For collection purposes, an adult is an individual age
eighteen or older at the time of the overpayment, except for individuals under
the age of twenty-two living in the home of their parent(s). Additionally,
collection is required from individuals under the age of eighteen when the
individual is the head of the assistance group or the only person in the
assistance group.
(2) Any person
connected to the assistance group, such as an authorized representative, who
actually trafficks or otherwise causes an overpayment or trafficking.
(3) A sponsor of an alien household member
when the sponsor is at fault or contributed to the claim.
(4) When a change in assistance group
composition occurs, county agencies may pursue collection action against any
assistance group that includes a member who was an adult member of the
assistance group that received the overpayment. The county agency may also
offset the amount of the claim against restored benefits owed to any assistance
group containing a member who was an adult member of the original assistance
group at the time the overpayment occurred.
(C) What are the three types of claims?
(1) Intentional program violation claim: any
claim for an overpayment or trafficking resulting from an individual committing
an intentional program violation. An intentional program violation is defined
in paragraph (B) of rule
5101:6-20-02
of the Administrative Code.
(2)
Inadvertent household error claim: any claim for an overpayment resulting from
a misunderstanding or unintended error on the part of the assistance
group.
(3) Agency error claim: any
claim for an overpayment caused by an action or failure to take action by the
county agency.
(D) When
is a claim considered an intentional program violation?
A claim shall be handled as an intentional program violation
claim when the overpayment or trafficking consisted of the individual
intentionally:
(1) Making a false or
misleading statement, or misrepresenting, concealing or withholding facts;
or
(2) Committing any act
constituting a violation of the Food and Nutrition Act of 2008, the
food assistance
SNAP program regulations, or any state statute for the
purpose of using, presenting, transferring, acquiring, receiving, possessing or
trafficking of
food assistance
SNAP benefits, or the electronic benefit transfer
(EBT) card.
(E) What
instances require an intentional program violation determination?
A claim shall be handled as an intentional program violation
claim only when an individual is disqualified as a result of:
(1) An administrative disqualification
hearing;
(2) A determination by a
federal, state, or local court;
(3)
Signing the JFS 04026 "Waiver of Administrative Disqualification Hearing
(rev. 1/2015); or
(4) Signing the JFS 04027 "Disqualification
Consent Agreement" (rev. 1/2015) in cases
referred for prosecution.
(F) When is a claim considered an inadvertent
household error?
A claim shall be handled as an inadvertent household error
claim when the overpayment was caused by:
(1) A misunderstanding or unintended error on
the part of the assistance group;
(2) A misunderstanding or unintended error on
the part of a categorically eligible assistance group provided a claim can be
calculated based on a change in net income and/or assistance group size;
or
(3) Social security
administration action or failure to take action resulting in the assistance
group's categorical eligibility, provided a claim can be calculated based on a
change in net income and/or assistance group size.
(G) What instances require an inadvertent
household error claim determination?
Instances of an inadvertent household error that may result in
a claim include, but are not limited to, the following;
(1) The assistance group unintentionally
failed to provide the county agency with correct or complete
information;
(2) The assistance
group unintentionally failed to report to the county agency changes in its
circumstances that it was required to report; or
(3) The assistance group unintentionally
received benefits or more benefits than it was entitled to receive pending a
fair hearing decision because the assistance group requested a continuation of
benefits based on the mistaken belief it was entitled to such
benefits.
(H) When is a
claim considered an agency error?
A claim shall be handled as an agency error claim when the
overpayment was caused by county agency action or failure to take action, or,
in the case of categorical eligibility, an action by a county agency or the
state or local government resulting in the assistance group's improper
eligibility for public assistance provided a claim can be calculated based on a
change in net income and/or assistance group size.
(I) What instances require an agency error
claim determination?
Instances of an agency error that may result in a claim
include, but are not limited to, the following:
The county agency:
(1)
Failed to take prompt action on a change reported by the assistance
group;
(2) Incorrectly computed the
assistance group's income or deductions, or otherwise assigned an incorrect
allotment;
(3) Incorrectly issued a
duplicate EBT card to an assistance group and the card was subsequently
transacted;
(4) Continued to
provide the assistance group with
food
assistance
SNAP benefits after its
certification period expired and no reapplication interview was conducted;
or
(5) Failed to provide an
assistance group a reduced level of
food
assistance
SNAP benefits because its
public assistance grant changed.
(J) When is a claim determination not
required?
A claim shall not be established when an overpayment occurred
due to the agency's failure to ensure the assistance group fulfilled the
following:
(1) Signed the application
form;
(2) Completed current work
registration; or
(3) Was certified
in the correct county.
(K) How is a claim documented against an
assistance group?
(1) The JFS 07424
"Reporting of Claim Determination/Lost Benefits"
(rev. 8/2001) shall be completed on all
food assistance
SNAP claims including trafficking related
claims.
(2) All JFS 07424 forms
shall be completed and properly filed at the county agency. The county
department of job and family services director or designee is responsible for
reviewing and approving all claims regardless of the amount.
(3) Prompt corrective action to prevent a
further overpayment is required.
(L) What is the claim management process and
what are the time frames for establishing claims?
(1) Within three months of the complaint, the
county agency shall screen to determine
if
when a potential claim exists.
If
When a
potential claim exists the claim shall be logged into the statewide automated
eligibility system. The date the complaint is entered into the system is the
"discovery or referral date" unless the referral of a potential claim is based
on a quality control finding as set forth in paragraph (L)(3) of this
rule.
(2) When a potential claim
exists, within five months of the "discovery or referral date", the county
agency shall investigate, obtain verification, calculate the claim and mail the
initial demand notice which is the "established date" unless a potential
intentional program violation exists. When a potential intentional program
violation exists the claim shall be referred to the county prosecutor or the
Ohio department of job and family services (ODJFS) bureau of state hearings for
an administrative disqualification hearing within three months of the date the
claim is calculated. Once the decision is rendered, the initial demand notice
is issued.
(3) For potential claims
based on quality control findings, within ten business days after receiving the
quality control finding the county agency shall enter the potential claim into
the statewide automated eligibility system. This is the "discovery or referral
date". The county agency shall investigate, obtain verification, calculate the
claim, and mail the initial demand notice within five months of the referral
date.
(4) The county agency shall
ensure that no less than ninety per cent of all claim referrals are either
established or disposed of according to the above time frames.
(M) What is the process when it is
determined that internal fraud or gross negligence has occurred during the
county certification process?
When it is determined by the United States department of
agriculture (USDA), or ODJFS in conjunction with USDA, that there has been
gross negligence or fraud on the part of the county agency in the certification
of assistance groups or the issuance of food
assistance
SNAP benefits, the county
agency will be liable for the dollar amount of benefits issued as the result of
such negligence or fraud.
Notes
Ohio Admin. Code
5101:4-8-15
Effective:
12/1/2020
Five Year Review (FYR) Dates:
7/24/2020 and
12/01/2025
Promulgated
Under: 111.15
Statutory
Authority: 5101.54
Rule
Amplifies: 329.04,
329.042,
5101.54
Prior
Effective Dates: 06/02/1980, 10/01/1981, 09/27/1982, 01/01/1983, 06/10/1983,
08/01/1983, 09/24/1983 (Temp.), 11/11/1983, 04/01/1984 (Temp.), 06/01/1984,
08/01/1984 (Emer.), 10/20/1984, 12/31/1984 (Emer.), 04/01/1985, 08/01/1985,
08/20/1986 (Emer.), 11/15/1986, 03/24/1988 (Emer.), 06/18/1988, 10/01/1988
(Emer.), 11/18/1988, 04/01/1989, 05/01/1989 (Emer.), 07/11/1989 (Emer.),
07/17/1989, 10/01/1990, 07/01/1994, 07/01/1995, 08/01/1995, 12/01/1995,
09/22/1996 (Emer.), 10/01/1996, 10/01/1996 (Emer.), 11/22/1996, 11/22/1996
(Emer.), 08/01/1998, 05/01/1999, 08/01/2001 (Emer.), 08/11/2001, 12/01/2002
(Emer.), 01/06/2003, 10/01/2007, 01/01/2011,
08/01/2015