Revision 15-4; Effective October 1, 2015

 

 

B—710 General Policy

Revision 11-1; Effective January 1, 2011

 

All Programs

An overpayment is the amount of benefits issued in excess of what should have been issued.

A claim is an amount owed by an individual for an overpayment of benefits or owed by an individual for benefits that are trafficked.

The date of discovery is the date the Office of Inspector General (OIG) substantiates that an overpayment occurred.

 

B—711 Types of Overpayment Claims

Revision 15-4; Effective October 1, 2015

 

All Programs

There are three types of overpayment claims:

  • agency error,
  • inadvertent household error/misunderstanding, or
  • fraud or intentional program violation (IPV).

OIG staff process overpayment referrals, determine the overpayment amount, and submit as a claim to the Texas Health and Human Services Commission (HHSC) Fiscal Management Services (FMS) to collect.

Related Policy
Referrals for Intentional Program Violation (IPV), B-900

 

B—720 When to File an Overpayment Referral

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must file an overpayment referral when a household receives benefits the household is not entitled to receive. When an overpayment occurs, OIG establishes a claim. The individual must repay any type of claim. The following situations do not cause an overpayment:

  • changes a household is not required to report;
  • overpayments that occurred more than six years before the date of discovery;
  • an unsigned Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
  • expired or missing employment services registration forms; or
  • households certified in the wrong county.

SNAP

Changes for categorically eligible households, except for changes in net income and/or household size, do not cause an overpayment. Exception: This does not apply to households that are categorically eligible based on receipt of Temporary Assistance for Needy Families - Non-Cash (TANF-NC).

OIG files a claim when an IPV is established against an individual for trafficking in Supplemental Nutrition Assistance Program (SNAP) benefits or access devices such as Electronic Benefit Transfer (EBT) cards.

 

B—730 How to File an Overpayment Referral

Revision 15-4; Effective October 1, 2015

 

All Programs

When an overpayment occurs, advisors determine the type of overpayment and enter an overpayment referral using the Automated System for Office of Inspector General (ASOIG) or the Texas Integrated Eligibility Redesign System (TIERS) referral interface. See B-770, Filing an Overpayment Referral, for overpayment referral instructions.

 

B—740 Texas Works Responsibilities

Revision 13-3; Effective July 1, 2013

 

All Programs

Texas Works staff:

  • identify overpayments;
  • enter all agency error, inadvertent household error/misunderstanding and fraud overpayment referrals using ASOIG or the TIERS referral interface, within 30 days of the date a potential overpayment is identified;
  • process fair hearing requests related to claims establishment or collection using the TIERS interface; and
  • forward any payments or warrants received at the local office, along with a copy of Form H4100, Money Receipt, within 24 hours of receipt to:

    Texas Health and Human Services Commission
    Fiscal Management Services
    ARTS Billing
    P.O. Box 149055
    Austin, TX 78714-9055

The Accounts Receivable Tracking System (ARTS) is administered by FMS staff who monitor and process payments from individuals who receive HHSC services. The ARTS Hotline number is 1-800-666-8531.

 

B—741 Texas Works Action on Agency Errors

Revision 11-1; Effective January 1, 2011

 

TANF and SNAP

When an agency error overpayment occurs, Texas Works staff:

  • correct the ongoing benefits, as needed, using adverse action procedures; and
  • enter an electronic overpayment referral using ASOIG or the TIERS referral interface within 30 days of the date a claim is identified.

Note: See B-770, Filing an Overpayment Referral, for instructions about how to complete and send an overpayment referral.

 

B—742 Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV)

Revision 15-4; Effective October 1, 2015

All Programs

When an overpayment is due to an inadvertent household error/misunderstanding or a potential IPV, Texas Works staff:

  • correct the ongoing benefits, as needed, using adverse action procedures; and
  • enter an overpayment referral using ASOIG or the TIERS interface within 30 days of the date a claim is identified.

Note: See B-770, Filing an Overpayment Referral, for instructions about how to complete and send an overpayment referral.

When an alien and the alien's sponsor are liable for an overpayment, both individuals are referred to the OIG.

The alien and the alien's sponsor are not referred for an overpayment claim if the sponsor also receives benefits in the same program in which the alien’s overpayment occurred.

 

B—750 Office of Inspector General (OIG) Responsibilities

Revision 11-1; Effective January 1, 2011

 

All Programs

The OIG General Investigations Division investigates allegations of recipient non-fraud overpayment and/or fraud. The General Investigations Division consists of the State Operations Unit with both Claims Investigation and Field Investigation units located throughout the state.

 

B—751 Office of Inspector General (OIG) Investigation Staff

Revision 15-4; Effective October 1, 2015

 

All Programs

OIG staff:

  • screen all types of referrals and investigate valid agency error, inadvertent household error/misunderstanding, fraud or IPV, individual and/or retailer EBT trafficking, and employee fraud;
  • process referrals including initiation of demand letters and establishment of claims;
  • negotiate methods of repayment;
  • set for active Eligibility Determination Groups (EDGs) a minimum amount of restitution at 10 percent of the monthly benefit or $25, whichever is greater;
  • respond to follow-up questions from individuals and staff about the validity of claims;
  • coordinate with Texas Works staff to process fair hearing requests related to claims establishment or collection; and
  • initiate the process to debit an EBT food account to repay a SNAP claim when the request is made prior to claim establishment.

 

B—752 Determining Claim Amounts

Revision 15-4; Effective October 1, 2015

 

All Programs

OIG staff take the following steps when determining claim accounts:

  • determine the first month of overpayment (see B-752.1, Determining the First Month of Overpayment);
  • exclude any months in which the household did not receive benefits or benefits were expunged;
  • follow applicable policy in A-1300, Income, to budget the overpayment months;
  • budget each month of an overpayment by using actual income amounts received for the month (the income is not converted);

    Exceptions: OIG staff:
    • budget the income originally projected at certification/redetermination when the income does not involve a required change; and
    • budget earned income as reported quarterly to the Texas Workforce Commission (TWC) to determine the overpayment amount when all efforts to verify earned income amounts have been exhausted; allow the household the opportunity to provide verification of actual gross pay per pay period; and recompute the overpayment if the individual provides the verification. Note: For cases sent to an administrative disqualification hearing, staff must verify the employment hire date when computing an overpayment based on TWC wage information.
  • do not allow earned income deductions for any earned income that the household failed to report timely as required and this failure caused an overpayment (deductions for overpayment months caused by an agency error are allowed);
  • for excess resource overpayment EDGs, compute earned interest income to estimate an account balance for the tax year, as reported annually by the Internal Revenue Service (IRS) through the Income and Eligibility Verification System (IEVS), to determine the overpayment amount when all efforts to verify an unreported financial institution account have been exhausted; allow the household the opportunity to provide verification of the interest income and the resource; and recompute the overpayment if the individual provides the verification;
  • subtract the amount the household was entitled to receive from the amount the household actually received before recoupment;

    Exception: There is no recoupment for Medical Programs.
  • total all the monthly amounts of overpayment; and
  • when the household is due unpaid restored benefits, offset the amount to be restored against the overpayment amount and document the offset according to B-831, Procedures for Counting Restored Benefits Toward a Claim.

Related Policy
Computing Benefits by EDG Action Type, A-1357
Reporting Requirements, B-620

TANF

When a child support payment was made during the overpayment month, the total income, less the $75 disregard, is counted to determine the overpayment amount.

 

B—752.1 Determining the First Month of Overpayment

Revision 11-1; Effective January 1, 2011

 

 

B—752.1.1 Errors at Certification

Revision 11-1; Effective January 1, 2011

 

All Programs

The first month of overpayment is the first month the household received more benefits than it was entitled to receive.

 

B—752.1.2 Errors After Certification

Revision 15-4; Effective October 1, 2015

 

All Programs

The first month of overpayment for non-streamlined reporting (SR) households is the month in which the change would have been effective had it been reported and acted on in a timely manner. However, the first month of overpayment can be no later than two months from the month the change occurred. Staff may use the following chart to determine the first month of overpayment.

If a change was... then the first month of overpayment is the month that begins more than...
reported timely, 23 days after the date the change was reported. (Example: Change occurred January 5 and was reported January 10. Count 23 days to February 2. March is the first month of overpayment.)
not reported timely, 33 days after the date the change occurred. (Example: Change occurred January 5. Count 33 days to February 7. March is the first month of overpayment.)

Exception: The first month of overpayment may be earlier for errors caused by moves out of state. The first month of overpayment may be as early as the month after all members of the household leave the state and there is duplicate participation in that month.

Charts in C-1140, TANF and SNAP Overpayment Determination Chart, provide help for determining the first month of overpayment for both timely and untimely change reports.

SNAP

An overpayment does not exist on a streamlined reporting EDG unless:

  • the household fails to timely report a required change, or
  • the agency fails to timely act on a reported change.

Note: The 10-day reporting requirement for SR EDGs is from the first payment that exceeds the 130 percent Federal Poverty Income Limit (FPIL) threshold. For example, an individual receives a pay raise effective May 15. The individual's gross monthly income exceeds the 130 percent FPIL with the June 27 paycheck. The household must report the change within 10 days of June 27 to be timely.

The first month of overpayment is the month after the second month the income exceeds the 130 percent FPIL for the household size. For example, income exceeds the 130 percent FPIL on June 27 and for the month of July. August is the first month of overpayment.

Related Policy
Reporting Requirements, B-620

 

B—753 Establishing Claims

Revision 13-3; Effective July 1, 2013

 

 

B—753.1 Identifying Liable Members

Revision 15-4; Effective October 1, 2015

 

TANF

The liable household members responsible for repayment of a claim are determined in the following order:

  1. The household that contains the caretaker or payee. Note: The caretaker may be an emancipated minor or minor parent who was certified separately.
  2. Any household that includes a household member who was an adult member at the time of the overpayment.

SNAP

The liable household members responsible for repayment of a claim are determined in the following order:

  1. The household that contains the head of household.
  2. Any household that includes a majority of adult members from the overpayment household.
  3. Any household that includes a household member who was an adult in the household at the time of overpayment.

TANF and SNAP

An authorized representative (AR) is liable for paying a claim when the AR causes an overpayment or traffics in SNAP benefits.

Sponsors and eligible aliens are jointly liable for overpayments resulting from incorrect information provided by the sponsor unless the sponsor:

  • can show good cause,
  • can show the eligible alien or sponsor was not at fault for the error, or
  • receives benefits in the same program in which the overpayment occurred.

The sponsor, alien, or both may appeal the amount or fault of an overpayment.

 

B—753.2 Demand Letters

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

OIG staff send Form OIG 5034, Notice of Food Stamp Overpayment Claim, and/or Form OIG 5039, Notice of TANF Overpayment Claim, along with Form OIG 5027, Repayment Agreement, to the individual. To be timely, OIG staff must send the letters no later than 180 calendar days from the date of discovery of the overpayment.

OIG staff send separate demand letters to the alien and the alien’s sponsor. The demand letter informs the sponsor that the sponsor is not responsible for the individual when the sponsor has good cause for the error, is not at fault, or receives benefits in the same program in which the alien’s overpayment occurred.

Note: Calls about demand letters for overpayments are referred to the local OIG unit for clearance.

 

B—753.3 Claim Disposition

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

OIG staff allow the individual 20 calendar days to respond to the demand letter. If the individual responds to the demand letter, the individual may agree to repay the overpayment by:

  • restitution, or
  • recoupment.

When the individual does not respond within 20 calendar days and the EDG is:

  • active, OIG staff initiate recoupment.
  • denied, OIG staff initiate restitution.

OIG staff establish the claim in ARTS using ASOIG within 10 calendar days of the individual's response, the response due date, or by cutoff of that month, whichever is earliest. Establishing the claim is delayed when the individual requests a fair hearing.

 

B—760 Fiscal Management Services (FMS) Responsibilities

Revision 13-3; Effective July 1, 2013

 

All Programs

FMS staff:

  • maintain ARTS;
  • manage the billing and collection process;
  • manage delinquent claims;
  • renegotiate methods of collection;
  • modify existing claims;
  • respond to inquiries from individuals or staff from the date the claim is established, including:
    • delinquent notices,
    • collection efforts,
    • federal payment intercepts through the Treasury Offset Program,
    • Unemployment Insurance Benefits intercepts; or
    • license suspensions;
  • process fair hearing requests related to claims establishment or collection;
  • initiate the process to debit an EBT food account to repay a SNAP claim when the request is made after the claim is established; and
  • provide claims data (via an interface) to the Office of the Attorney General to offset TANF and child support payments.

 

B—761 Claims Collection

Revision 11-1; Effective January 1, 2011

 

 

B—761.1 Recoupment

Revision 11-1; Effective January 1, 2011

 

TANF and SNAP

Recoupment is a method of recovering an overpayment claim by withholding a portion of the household's benefits.

 

B—761.1.1 Action on Recoupment Cases

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Recoupment is initiated when OIG staff enters a claim against a household into ARTS. ARTS interfaces with TIERS to automatically reduce the household's ongoing benefits.

When an EDG is denied or the certification expires and the recoupment is incomplete, ARTS performs an automatic search to find another household member who is liable for the overpayment on an active EDG of the same program type. When ARTS:

  • finds no liable member, it sends a bill to the individual to request payment of the remaining balance and transfers the claim to restitution. See B-753.1, Identifying Liable Members, and B-761.2, Restitution.
  • finds a liable member, it transfers the recoupment to the active EDG.

A denied EDG is never purged from TIERS or ARTS when there is a recoupment record or a claim with a remaining balance. If the EDG is recertified, ARTS automatically resumes recoupment.

Notes:

  • FMS staff may negotiate a repayment agreement with the individual.
  • FMS staff are authorized to make corrections to the recoupment records in ARTS.

Recoupment information is available through TIERS inquiry, ARTS inquiry, or by calling the ARTS Hotline at 1-800-666-8531.

 

B—761.1.2 Recoupment Hierarchy

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Claims are recouped by error type in the following order.

  1. Type A — IPVs (fraud)
  2. Type J — inadvertent household error/misunderstanding
  3. Type L — agency error

All three claim types can be simultaneously stored on ARTS. Recoupment of a Type A claim places Type J and L claims on hold status until the Type A recoupment is completed. ARTS automatically resumes recoupment of the Type J or L claim when all of the individual's Type A claims have been paid in full.

 

B—761.1.3 Recoupment Amount

Revision 15-4; Effective October 1, 2015

 

TANF

HHSC recoups Type A, J, and L claims at 10 percent of the household's maximum grant, rounded down to the nearest dollar.

Once a TANF claim is recouped in full, TIERS will automatically rebudget any active SNAP EDG to include the appropriate ongoing TANF grant amount. See A-1324.18, Temporary Assistance for Needy Families (TANF).

SNAP

For Type A claims, HHSC recoups at 20 percent of the household allotment or $20, whichever is greater. When calculating a dollar amount using the percentage, TIERS rounds 49 cents down and 50 cents up to the next whole dollar.

For Types J and L claims, HHSC recoups at 10 percent of the household allotment or $10, whichever is greater. When calculating a dollar amount using the percentage, TIERS rounds 49 cents down and 50 cents up to the next whole dollar.

Notes:

  • When benefits are $10 or less, no benefits are issued.
  • When a current household member is disqualified for an IPV, recoupment is computed using the allotment the household would receive if the disqualified member was included in the household size.

 

B—761.2 Restitution

Revision 11-1; Effective January 1, 2011

 

TANF and SNAP

Restitution is a method of recovering an overpayment claim by the receipt of payments in the form of a cashier's check, certified or personal check, and/or money orders made payable to the Texas Health and Human Services Commission.

 

B—761.2.1 Action on Restitution Cases

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

When the EDG is active and the individual misses a payment or makes a partial payment, ARTS sends a delinquency notice and initiates recoupment on the EDG after expiration of the advance notice period.

SNAP

ARTS initiates recoupment on the active EDG to repay the claim when the EDG is denied, and:

  • the individual fails to respond to the ARTS notice within 10 days; and
  • ARTS finds an adult household member who is liable for the overpayment on an active EDG of the same program.

When ARTS finds no liable adult household member on an active EDG, the claim is eligible for referral to:

  • the Federal Treasury Offset Program for an intercept of federal payments;
  • TWC for voluntary garnishment of Unemployment Insurance Benefits;
  • the Texas Lottery Commission for an intercept of lottery winnings;
  • applicable agencies to request suspension of licenses; or
  • a private collection agency.

Restitution information is available through the ARTS inquiry or by calling the ARTS Hotline at 1-800-666-8531.

 

B—761.2.2 Restitution Amount

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When an EDG is active, OIG staff are responsible for setting the amount of restitution at 10 percent of the monthly benefit or $25, whichever is greater.

When an EDG with a recoupment claim is denied, ARTS transfers the claim to restitution. ARTS sends a monthly billing statement to the individual for a minimum collection of $25.

 

B—762 Action on Receipt of Payments

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When staff receive restitution payments from individuals, staff:

  • complete Form H4100, Money Receipt; and
  • submit the payment or warrants with a copy of Form H4100 within 24 hours of receipt to:

    Texas Health and Human Services Commission
    Fiscal Management Services
    P.O. Box 149055
    Austin, TX 78714-9055

Note: When staff receive TANF warrants, each warrant is marked void.

 

B—763 Debit of SNAP EBT Accounts

Revision 13-3; Effective July 1, 2013

 

SNAP

Debit of an EBT food account is a method of recovering an overpayment claim by electronically removing benefits from the household's EBT account. The value of the debit is applied to the SNAP claim.

 

B—763.1 One-Time Debit of an Active EBT Account

Revision 15-4; Effective October 1, 2015

 

SNAP

When an individual (primarily liable or authorized representative) requests a one-time debit of the EBT food account to pay a SNAP claim and the EBT account is active, OIG or FMS staff:

  • use the Administrative Terminal Application (ATA) to verify the:
    • status of the individual's EBT food account; and
    • balance of the account;
  • complete Form H1021, Payment Agreement — Verbal Authorization for One-Time Debit of an Active Lone Star Food Account (this form documents the individual's verbal authorization to repay the overissuance by removing benefits from the active EBT food account);
  • inform the individual that:
      • the amount of the one-time payment must be maintained in the individual's account until the debit is completed;
      • it takes approximately 14 days for the debit transaction to be completed; and
      • the individual will receive a receipt of the debit within 10 days of the debit transaction; and
  • submit the original of Form H1021 to:

    HHSC Lone Star Business Services
    State Office
    Mail Code 2033

    Maintain a copy of Form H1021 in the OIG or ARTS file.

Lone Star Business Services staff remove the SNAP benefits from the food account and submit Form H1021 to ARTS in FMS to repay the claim. ARTS staff send a receipt to the individual for the amount listed on Form H1021 within 10 days of the debit transaction.

Note: When the individual contacts HHSC and disagrees with the debit transaction, the individual may request a fair hearing to request the return of the benefits to the individual’s account.

 

B—763.2 Debit of a Dormant EBT Account

Revision 15-4; Effective October 1, 2015

 

SNAP

When the individual requests a debit of the EBT food account to pay a SNAP claim and the EBT account is dormant, then OIG or ARTS staff:

  • use the ATA to verify the:
    • status of the individual's EBT food account; and
    • balance of the account;
  • complete and send the original Form H1022, Notice to Apply Benefits in a Dormant Lone Star Food Account to a Food Stamp Claim, to the individual (this form notifies the individual that benefits will be removed from the EBT food account to pay a SNAP claim); and
  • allow the individual (prior to processing the debit) 10 days from the date of the request to notify OIG or ARTS staff that the individual does not want HHSC to use the benefits in the EBT food account to pay a SNAP claim.

If the individual does not contact OIG or ARTS staff by the 10th day after the individual requested the debit, Claims Investigations or ARTS staff submit a copy of Form H1022 to:

HHSC Lone Star Business Services
State Office
Mail Code 2033

A copy of Form H1022 must be maintained in the OIG or ARTS file.

Lone Star Business Services staff remove the SNAP benefits from the food account and submit Form H1022 to ARTS in FMS to repay the claim.

 

B—763.3 Monthly Debit of an Active EBT Account

Revision 15-4; Effective October 1, 2015

 

SNAP

When the individual requests a monthly debit of an active EBT food account to pay a SNAP claim, OIG or ARTS staff:

  • use the ATA to verify the:
    • status of the individual's EBT food account; and
    • balance of the account;
  • complete and send Form H1023, Installment Payment Agreement — Debit of a Lone Star Food Account, to the individual (obtain the individual's signature and amount of monthly debit on Form H1023 — this form indicates that the individual agrees to repay a SNAP claim by a monthly debit of the EBT food account);
  • inform the household that they must maintain the agreement amount in the account each month until the debit is completed, and that the agreement may be revoked at any time; and
  • submit the original Form H1023 to:

    HHSC Lone Star Business Services
    State Office
    Mail Code 2033

    A copy of Form H1023 must be maintained in the OIG or ARTS file.

Lone Star Business Services staff remove the SNAP benefits from the food account each month and send a copy of Form H1023 to ARTS in FMS to repay the claim.

 

B—763.4 Offset Expunged Benefits

Revision 11-1; Effective January 1, 2011

 

SNAP

When staff become aware that a household has expunged SNAP benefits, OIG or ARTS staff must offset the balance of a SNAP claim by the amount of the expungement.

 

B—764 Fair Hearings

Revision 15-4; Effective October 1, 2015

TANF and SNAP

When it is unclear whether the household wishes to appeal a Texas Works advisor's EDG action or an action taken by OIG staff, local eligibility office staff and OIG review the request for an appeal to determine what action the household is truly appealing. If a household disputes the establishment of a claim or collection action and requests an appeal, OIG will take the lead and begin processing the appeal.

The following procedures are used to submit an appeal request. Form H4800, Fair Hearing Request Summary, is not used, but Form H4800, sent directly to the hearings division, will be returned to staff with instructions to correctly submit the information.

OIG Staff

OIG staff use the TIERS Hearings and Appeal functional area located in the left navigation menu to submit appeal requests on claims or on collection actions.

OIG staff use the State Portal Appeals tab and then the Hearing Evidence Packets Upload tab to transmit evidence documents related to an appeal request.

Texas Works Staff Working in TIERS

Eligibility staff process fair hearing requests using the State Portal Appeals tab when an individual verbally requests an appeal.

If the fair hearing request is received in writing (by fax or mail, for example), eligibility staff fax the appeal request, using the fair hearing cover sheet, through the expedited fax line (1-866-559-9628) for processing. The fair hearing request is not entered in the State Portal.

Whether the TIERS appeal request is received verbally or in writing, the Centralized Representation Unit continues to process the appeal, including creating and submitting the evidence packet. Copies of the evidence packet are mailed to the appellant and any authorized or legal representative.

 

B—770 Filing an Overpayment Referral

Revision 12-2; Effective April 1, 2012

 

 

B—771 Filing an Overpayment Referral Using Automated System for the Office of Inspector General (ASOIG)

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff create referrals for overpayments caused by agency error, individual error/misunderstanding, or suspected IPV or fraud in ASOIG.

ASOIG is accessed at the following website: https://hhsportal.hhs.state.tx.us/asoig.

Users log in using a unique sign on. A disclaimer page explaining IRS Federal Tax Information requirements must be agreed to before proceeding with the referral. Agreement takes the user to the ASOIG home page.

Investigation is selected from the left navigation menu to proceed to the Referral and Investigation search page. Users must enter identifying information and select Create Referral.

Identifying information may consist of one or more of the following:

  • Suspect name,
  • Individual (client) number,
  • Social Security number, or
  • EDG or case number.

The Create Referral tab takes the user to the Create Referral screen group. This consists of the Referral, Suspects, Reasons, Contacts, Comments and Assignment tabs. The user must go through all tabs, enter information as appropriate, and save the referral.

The Referral tab is the first tab in creating a referral. The tab has two areas. The top part, Alleged Information, is for entering biographical information. The bottom portion, EDG Types, is used to enter whatever program type information is known.

The New button at the bottom of the tab is used when adding types to the EDG Types portion of the tab. If the referral is associated with more than one EDG, users must click the New button to add additional types. The user must continue to click the New button until all EDGs associated with the referral are added. Once all types have been entered, the user must click the Next button to proceed to the next tab, Suspects.

The Suspects tab is used to enter information on suspects as well as household members associated with the referral. The top portion of the screen, Suspect, allows for the entry of any known biographical information. The bottom portion, Address, is for entering any known address(es).

At least one suspect screen with a name and type of suspect is required for a referral. Although children are not "suspects," entering all household members is recommended as that information will be required if an investigation is merited.

If an automated interface finds information in TIERS, users may select from a list of names. If a name is chosen from the list in this field, the ASOIG populates applicable biographical and EDG information such as date of birth, Social Security number and address. If TIERS information is not found, users must enter all known information.

The New button on the tab is to allow the user to include all household members in the referral. Once all members are entered, the user must click the Next button to advance to the next tab, Reasons.

The Reasons tab is used to establish the basis for the referral. The screen is divided into three sections, Reason, Source Information and Source Detail. One reason type and name is required for each referral.

Multiple reasons may be entered on a single referral. If there are multiple reasons, users enter the information for the first reason and then click the New button to enter information for the next reason. Once all applicable reasons are entered, the user must click the Next button to move to the next tab, Contacts.

The Contacts tab is used to enter sources of information such as another employee, agency or other person with information about the referral. The screen is divided into two sections. The Contact portion is for information on the source of information while the Address portion is for documenting any address information for the contact.

A Contacts entry is not required for a referral, but multiple entries may be made by clicking the New button. Clicking on the Next button takes the user to the next tab, Comments.

The Comments tab is used to enter information on the referral. It is used to document information not otherwise captured by ASOIG. At least one comment is required and multiple comments may be entered. Comments are listed by subject, and users should enter a concise statement in the subject to describe the contents of the comment.

Comments may be linked to a Contact by clicking the Related Contact checkbox.

Once a comment is saved by clicking the New or Next button, it cannot be modified. Care must be exercised in completing this tab. Clicking the Next button takes the user to the final tab, Assignment.

The Assignment tab allows the assignment of the referral based on predefined rules. Once the Save Referral button is clicked, the referral is saved and all information is locked, except for the ability of the user to include additional comments.

Saving the referral takes the user back to the Referral tab; however, it is only for viewing, and the user now has the ability to attach any electronic documents saved on the user's computer to the referral. Attach documents by clicking the paper clip icon next to the tabs, browse to select the document, give a name to the document, describe the contents of the document and click Save. Multiple documents may be attached using the New button.

Note: Logging out of the referral before it is saved on the Assignment tab will result in loss of information entered, requiring the user to start over.

 

B—772 Filing an Overpayment Referral Using TIERS

Revision 15-4; Effective October 1, 2015

 

SNAP and TANF

When eligibility staff discover that an overpayment exists, either by advisor knowledge or because it is identified in the TIERS Eligibility Summary, the following steps must be taken to enter the referral in TIERS:

  • From the left navigation menu, the user must go to Data Collection > Initiate Interview and enter the case number and case mode. If a case is already in ongoing mode, the user may enter the referral.
  • From the left navigation menu, the user must select Data Collection > Miscellaneous > Referral. The TIERS referral summary page will display. If an overpayment claim exists for the EDG, there will be an entry for the advisor to review on this page. To review the claim, the user must click on the edit icon.
  • To enter a new referral, the user must click the red Add button.
  • On the Details page, the user must enter the following information:
    • Name – From the drop-down menu, select the name of the individual causing the overpayment.
    • Effective Begin Date – Enter the date the overpayment began.
    • Discovery Code – From the drop-down menu, select the most appropriate entry to describe how the overpayment was discovered. If no entry is appropriate, select "other."
    • Error Referral Type – From the drop-down menu, select an entry based on the entity causing the error. For errors caused by the agency's error or failure to take action in a timely manner, select "agency." For errors caused by individuals without the intent to commit fraud, select "client." For errors where eligibility staff believe the individual intentionally committed fraud to receive additional benefits, select "fraud."
    • Overpayment Reason – From the drop-down menu, select the most appropriate reason for the overpayment. If no entry is appropriate, select "other."
    • Overpayment Discovery Date – Enter the date HHSC discovered the overpayment.
    • Benefit Type – From the drop-down menu, make the appropriate selection based on the type of benefit overpaid.
    • Financial Penalty Code – For overpayments caused by TANF Personal Responsibility Agreement (PRA) noncompliance, select the area with which the individual noncomplied.
    • Destination Unit – Select the appropriate unit by region and by the type of referral (CI – Claims Investigation/FI – Fraud Investigation).
    • Referral Benefit Restored Amount – If the overpayment was caused by the issuance of restored benefits, enter the overpayment amount in this field. If the overpayment was not caused by the issuance of restored benefits, a zero entry remains in this field.
    • Form 1898 Completion Date – This field is used for overpayment claims caused by the issuance of restored benefits only. Enter the date Form 1898, Restored Benefits Documentation, was completed at the time the restored benefits were authorized.
    • First Month and Year of Overpayment – Enter the month and year the overpayment began. Estimate only.
    • Last Month and Year of Overpayment – Enter the month and year the overpayment ended. Estimate only.
    • Overpayment Amount – Enter the dollar amount of the overpayment for all referrals except referrals based on restored benefits. If the overpayment was caused by the issuance of restored benefits, this field should contain a zero entry. Estimate only.
    • EDG Participation – For the individual causing the overpayment, select whether or not the individual was a member of the certified group.
    • Participation Change Date – For claims based on household changes, enter the date the participation status changed for the individual causing the overpayment.
    • Participation Change Report Date – For claims based on household changes, enter the date HHSC learned of the household change.
    • Enter comments you wish OIG to receive by entering page-level comments on this page – Click on the center icon next to the Referral – Details title to enter page-level comments.
  • On the Income page (for overpayments caused by income only), if known, the user enters the following information:
    • Source Type – From the drop-down menu, select "earned income" or "unearned income" depending on the type of income causing the overpayment.
    • Source Name – Enter the name of the entity that provided the income that caused the overpayment. This may be the name of an individual, company or government agency.
    • Verification Source – From the drop-down menu, make the appropriate verification source selection. If the source used to verify the income is not available on the menu, select "none" and document the source in page-level comments on the details tab.
    • Source Hire Date – For earned income overpayments, enter the hire date for the individual.
    • First Check Date – Enter the date the individual received the first payment that caused the overpayment. Note: This could be a check or cash payment, and the payment could be for earned and unearned income.
    • Source Report Date – Enter the date the individual informed HHSC of the income change.
    • Source Amount – Type the monthly amount of the income received from the source.
    • Income Source Address – If known, enter the address of the income source.
  • On the Resources page (for overpayments caused by resources only), if known, the user enters the following information:
    • Resource Type – From the drop-down menu, select the most appropriate entry for the type of resource causing the overpayment. If no selection is appropriate, select "other."
    • Resource Change Date – Enter the date the individual obtained possession of the resource.
    • Resource Report Date – Enter the date HHSC learned of the resource change.
    • Resource Amount – Enter the countable value of the resource.
  • The user must document the overpayment referral and reason in TIERS Case Comments.

 

B—780 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Advisors must document in TIERS Case Comments:

  • that an overpayment referral was made via ASOIG or through the TIERS interface, according to B-730, How to File an Overpayment Referral; and
  • a brief description of the overpayment, and how and when the overpayment was discovered, according to B-711, Types of Overpayment Claims.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide