Revision 09-1; Effective July 20, 2009

 

 

9100 Overview

Revision 09-1; Effective July 20, 2009

 

Individuals or families who meet federally established eligibility requirements may apply for a grant under the Federal Assistance to Individuals and Households Program (IHP). These individuals or families must have serious needs or necessary expenses resulting from a catastrophe declared a disaster by the President and must be eligible in certain categories. The total grant for all categories may not exceed the maximum established by federal law. The maximum grant amount is adjusted annually, at the beginning of the fiscal year (October), to reflect changes in the Consumer Price Index. The grant may not duplicate assistance received from insurance or other agencies; therefore, the grant determination process requires close coordination and exchange of information between the Texas Health and Human Services Commission (HHSC) and other agencies. See Item 10130, Duplication of Benefits, for more information.

When a disaster victim completes an application through teleregistration or online, Federal Emergency Management Agency (FEMA) staff refer him to the Other Needs Assistance (ONA) provision of IHP if (a) he has uninsured losses and the Small Business Administration (SBA) declines a loan for income reasons, or (b) if he has uninsured medical, dental or funeral expenses. FEMA damage assessment staff verify losses through a home visit, and document ownership and primary residency. Inspection information is transmitted from the Automated Construction Estimator (ACE) system to FEMA's National Emergency Management Information System (NEMIS) at the assigned Processing Service Center (NPSC). NPSC notifies ONA staff of cases ready to be worked by transmitting the case via NEMIS. ONA staff access NEMIS to review application, inspection and duplication of benefits information.

After a review process, ONA staff notify the victim of the decision and, if the application is approved, of the requirements for using the grant. The victim is also notified of his right to request a reconsideration if he does not agree with the decision. If the victim requests reconsideration, ONA staff notify him by letter of the review decision and of his right to formally appeal to the HHSC Hearings Department.

The disaster victim is referred to as the applicant in the following sections.

 

9200 Loss Verification

Revision 05-1; Effective October 1, 2004

 

To determine eligibility for participation in the ONA provision of IHP, the applicant's claim for disaster losses must be verified for each category of assistance. For personal property and transportation losses, verification involves an on-site inspection of the damaged property by an inspector. Claims for assistance regarding medical/dental/funeral expenses must be supported by bills or receipts. NEMIS contains information about assistance from other agencies such as the SBA, American Red Cross, FEMA-administered Housing Assistance (HA) provision of the Federal Assistance to Individuals and Households Program (IHA), and National Flood Insurance Program. The applicant must provide private insurance coverage information when he applies. He will be informed that his ONA application will be processed only if his insurance settlement does not cover his disaster losses and he requests assistance by re-contacting FEMA on the toll-free number provided. For uninsured applicants, the worker must determine eligibility, based on serious need and necessary expense criteria, and calculate the amount of grant or deny the application.

 

9210 FEMA Loss Verification

Revision 05-1; Effective October 1, 2004

 

FEMA staff provide ONA staff most of the verification data about uninsured ONA applicants who are ineligible for an SBA loan. FEMA is responsible for performing most of the required verifications in these categories:

  • housing (including documentation of home ownership and primary residency),
  • personal property, and
  • transportation.

Inspectors enter damage report information into the ACE system. ACE data is downloaded to NEMIS for review by FEMA's Housing Assistance and ONA eligibility staff.

 

9220 ONA Loss Verification

Revision 05-1; Effective October 1, 2004

 

The ONA staff is responsible for verifying:

  • medical/dental claims, and
  • funeral claims.

 

9300 Conflict of Interest

Revision 05-1; Effective October 1, 2004

 

All ONA staff must avoid any conflict of interest between their assigned duties and personal interests. Staff must avoid directing victims applying for grants to specific contractors for home repairs or to a service center for repair of personal property. Staff must also avoid processing cases of close friends or relatives. These cases should be referred to the eligibility supervisor. If the potential conflict involves the eligibility supervisor, referral should be made to the grant coordinating officer. In any situation involving conflict of interest, the case should be referred to the next highest level within the department's organizational structure. Details on department rules regarding conflict of interest and standards of conduct are in the Human Resources Manual, Chapter 4, Employee Conduct. Supervisors of temporary employees should determine if this information was given to their employees during personnel orientation and, if not, ensure that it is provided to them during ONA training.

 

9400 Confidentiality

Revision 09-1; Effective July 20, 2009

 

ONA procedures for safeguarding the privacy of applicants and the confidentiality of information will comply with HHSC's policy concerning public inquiries and disclosure of information, which includes HIPAA compliance.

 

9500 Case Flow

Revision 09-1; Effective July 20, 2009

 

The disaster victim applies for a grant by calling the toll-free number at the National Teleregistration Center (NTC). Telephone applications are directly entered into the computer system at the NTC.

The NTC transmits application information to FEMA's computer system, NEMIS, at the National Processing Service Center (NPSC). Applications listing income below the minimum required for referral to the SBA loan program are coded as SBA denials. NPSC assigns the applications to the FEMA contract monitor for assignment to individual inspectors. However, medical/dental and funeral cases are transmitted directly to the ONA office.

The inspector makes a home visit and completes the inspection report. Inspectors enter information into the Automated Construction Estimator (ACE) by using a Grid Palm Pad to record inspection information. Individual inspectors transmit case inspection information to the ACE mainframe computer in Redwood City, Calif.

The completed inspection report information is downloaded to the NPSC. NPSC review unit staff, who are trained in Housing Assistance program policies, review the application and inspection information and determine eligibility for the Housing Assistance provision of IHP. NPSC then notifies the ONA program office via electronic transmittal which applications are ready to work.

ONA staff receive an electronic transmittal of cases ready to be worked. Workers access FEMA's NEMIS computer system to review application, inspection and duplication of benefits information. ONA automation staff also download the application information into the HHSC System.

The ONA eligibility worker determines grant eligibility on cases that are not automatically determined by NEMIS, enters the decision in NEMIS, and determines which notices must be mailed to the applicant. Cases marked with "IDV_FAILED," in the banner on NEMIS, indicates the applicant’s name and Social Security number do not match and will be sent an IDV_Failed denial letter and be given 60 days to comply with identification verification. Case decisions are normally reviewed by a supervisor before transmittal from NEMIS to the ONA payment system.

Case decision information is transmitted from the ONA computer system to the HHSC System. For approvals, checks or electronic funds transfers are issued by the Comptroller of Public Accounts office, returned to the Health and Human Services Accounting System (HHSAS), and sent to the applicants.

FEMA is responsible for mailing notification letters to the applicant's mailing address.

If additional information has been requested from the applicant, the work packet for that category automatically is sent to the Pending Receipt file in NEMIS until the information is received or the due date arrives. All correspondence will have the FEMA NPSC mailing address. When correspondence is received from the applicant, NPSC staff scan the document in NEMIS and transmit a "pending" work packet to ONA. ONA staff review the document and take appropriate action to determine eligibility. If the due date arrives without receipt of information, the file is automatically denied for that category. If information is received, the document is placed in NEMIS and a workpack is submitted to a worker for a decision.