Revision 20-4; Effective October 1, 2020

 

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 19-4; Effective October 1, 2019

 

All Programs

Staff must file an overpayment referral when a household receives benefits the household is not entitled to receive. When an overpayment occurs, OIG establishes the claim. The household must repay any type of overpayment claim.  

If the household reports a change and staff does not take the appropriate action or fail to act on an agency-generated change, an overpayment referral must be filed.

Do not file an overpayment referral if the overpayment was due to:

  • a change the household is not required to report; or
  • an overpayment that occurred more than six years before the date of discovery.

 

SNAP

Changes for categorically eligible households, except for changes in net income, household size or both, do not cause an overpayment.

Exception: This does not apply to households who are categorically eligible based on receipt of Temporary Assistance for Needy Families - Non-Cash (TANF-NC).

OIG files a claim when an intentional program violation (IPV) is established against a person for trafficking Supplemental Nutrition Assistance Program (SNAP) benefits or accessing 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 19-4; Effective October 1, 2019

 

All Programs

The OIG Benefits Program Integrity (BPI) department investigates allegations of recipient non-fraud overpayment and fraud. The BPI department consists of the claims investigation and field investigation units located throughout the state.

 

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

Revision 19-4; Effective October 1, 2019

 

All Programs

OIG staff:

  • screen all types of referrals and investigate valid agency error, inadvertent household error or misunderstanding, fraud, IPV, individual or retailer EBT trafficking, and employee fraud;
  • process referrals including initiation of demand letters and establishment of claims;
  • set restitution or recoupment amounts for active Eligibility Determination Groups (EDGs);
  • respond to follow-up questions from people who receive benefits 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.

 

Related Policy
Texas Works Responsibilities, B-740
Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV), B-742
Texas Works Action on Agency Errors, B-741

 

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 19-4; Effective October 1, 2019

 

TANF, One-Time TANF (OTTANF), and One-Time Grandparent Payments

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

  • Caretaker or payee.
  • Second parent or step-parent who was an adult household member at the time of the overpayment.

SNAP

The liable household member responsible for repayment of a claim is determined in the following order:

  • The head of household.
  • Any household member who was an adult 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 Notices

Revision 19-4; Effective October 1, 2019

 

TANF and SNAP

OIG staff send either Form OIG 5034, Notice of SNAP Overpayment Claim, or Form OIG 5039, Notice of TANF Overpayment Claim or both, along with Form OIG 5027, Repayment Agreement, to the household.

To be timely, OIG staff must send the notice no later than 180 calendar days from the date the investigation was created in the Automated System for Office of Inspector General (ASOIG).

When the case involves an alien with a sponsor, OIG staff send separate demand notices to the alien and the alien’s sponsor. The demand notice informs the sponsor that the sponsor is not responsible for the person when:

  • the sponsor has good cause for the error;
  • is not at fault; or
  • receives benefits in the same program that the alien’s overpayment occurred.

Note: Calls about overpayment demand notices are referred to the local OIG unit for clearance.  Local office contacts can be found by clicking on this link: OIG Facilities Local Office Contacts.

After navigating to the website, click on “OIG Facilities Local Office Contacts” on the right side of the page.

 

B—753.3 Claim Disposition

Revision 19-4; Effective October 1, 2019

 

TANF and SNAP

OIG staff mail a household a repayment agreement notice and an overpayment claim notice. A claim in the Accounts Receivable Tracking System (ARTS) is then established the same date of the notice.

The claim notice provides:

  • an explanation of how the overpayment claim amount was calculated;
  • repayment options (either restitution or recoupment); and
  • information about the person’s right to request a fair hearing within 90 days of the effective date of claim notice.

The person indicates whether they prefer to repay the claim by restitution or recoupment on the repayment agreement notice and must return the agreement within 30 days of receipt.  

Repayment of the claim is delayed only when the person requests a fair hearing.

 

B—760 Fiscal Management Services - Accounts Receivable Responsibilities

Revision 19-3; Effective July 1, 2019

 

All Programs

HHSC Accounts Receivable staff:

  • maintain the Accounts Receivable Tracking System (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; and
    • license suspensions;
  • process fair hearing requests related to claims establishment or collection (if the request is past 90 days from the claim origination date); and
  • initiate the process for one-time debits of an EBT food account to repay a SNAP claim when the request is made after the claim is established.

 

B—761 Claims Collection

Revision 11-1; Effective January 1, 2011

 

 

 

B—761.1 Recoupment

Revision 19-3; Effective July 1, 2019

 

TANF and SNAP

Recoupment, also known as allotment reduction, 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 20-2; Effective April 1, 2020

 

TANF and SNAP

Recoupment is initiated when Office of Inspector General (OIG) staff enter a claim against a household into the Accounts Receivable Tracking System (ARTS). ARTS interfaces with TIERS to automatically reduce the household's benefit allotment if any liable household member is currently receiving benefits.

Overpayments are recouped from all identified liable household members. When persons liable for an overpayment currently reside in separate households, overpayments are recouped from all liable household members until all claims are paid in full. When a liable household member is currently disqualified but on an active case, overpayments are recouped from the household benefit allotment received by the other certified members.

Follow policy in B-761.2.1, Action on Restitution Cases, if there is no liable household member currently receiving benefits to recoup from.

If a liable household member begins receiving benefits, TIERS automatically begins the recoupment process from the new benefit allotment. TIERS continues to recoup the newly certified benefits until the claim is paid in full.

Notes:

  • HHSC Accounts Receivable staff may negotiate a repayment agreement with the household. However, if a claim is being recouped or has been sent to the U.S. Treasury for collection, HHSC Accounts Receivable will not enter into a new repayment plan.
  • HHSC Accounts Receivable 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 Accounts Receivable Customer Service Hotline at 800-666-8531.

Related Policy

Identifying Liable Members,  B-753.1
Recoupment Amount, B-761.1.3
Action on Restitution Cases, B-761.2.1

 

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 19-3; Effective July 1, 2019

 

TANF and SNAP

Restitution is a method of recovering an overpayment claim by receiving payments in the form of a cashier's check, certified or personal check, money orders made payable to the Texas Health and Human Services Commission, or credit or debit card payments through the Texas.gov HHSC Online Overpayment System (HOOPS).

 

B—761.2.1 Action on Restitution Cases

Revision 20-2; Effective April 1, 2020

 

TANF and SNAP

When OIG establishes an overpayment claim, Form OIG 5027, Repayment Agreement is sent to the primary liable household member along with Form OIG 5034, Notice of SNAP Overpayment Claim, or Form OIG 5039, Notice of TANF Overpayment Claim.

The primary liable household member has 30 days from the date on the repayment agreement to agree to restitution by signing the agreement and returning it to the OIG investigator. The repayment agreement provides the household with both the signature and first payment due date.

OIG staff are responsible for sending the repayment agreement, signed or unsigned, to HHSC Accounts Receivable for processing as soon as it is received. For the household to avoid delinquency, all payments must be sent to HHSC Accounts Receivable on or before the 30th day from the date on the repayment agreement.

If a household has delinquent restitution payments and TIERS is unable to match an overpayment claim to a liable household member currently receiving benefits, then the overpayment claim is eligible for referral to the:

  • Federal Treasury Offset Program (TOP) for an intercept of federal payments (only applicable to SNAP claims once the payment is 120 days delinquent);
  • Texas Comptroller of Public Accounts for interception of any state payments, including lottery winnings; or
  • appropriate agencies to request suspension of licenses.

Restitution payments cannot be made in lieu of mandatory recoupment. If a liable household member is making restitution payments and becomes certified on an active case, then the liable household member is switched from a restitution payment plan to a recoupment payment plan. Recoupment begins after the first month of certification. Once ARTS receives notification from TIERS of the first recoupment payment from the active case, ARTS automatically switches the payment plan from restitution to recoupment.

If the household was on a restitution payment plan and receiving bills, all billing will stop until the household stops receiving benefits or when the claim is paid in full.

In order to pay down their overpayment balance, households may make extra restitution payments in addition to their mandatory repayment or recoupment payments.

Related Policy

Identifying Liable Members, B-753.1
Action on Recoupment Cases, B-761.1.1
Restitution Amount, B-761.2.2

 

B—761.2.2 Restitution Amount

Revision 19-3; Effective July 1, 2019

 

TANF and SNAP

The repayment agreement reflects a 36-month amortized schedule for the claim to be repaid within three years. If the amortized monthly payment is less than $25, then the agreement is generated with $25 as the minimum payment.

Only HHSC Accounts Receivable staff can renegotiate a payment plan differing from the one on the repayment agreement. Accounts receivable staff sends all subsequent monthly bills or repayment agreements to households after OIG sends the initial repayment agreement.

 

B—762 Action on Receipt of Payments

Revision 19-3; Effective July 1, 2019

 

TANF and SNAP

When staff receive restitution payments, 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
    Accounts Receivable
    P.O. Box 149055
    Austin, TX 78714-9055

Note: Staff must mark each TANF warrant void when received.

 

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 20-2; Effective April 1, 2020

 

SNAP

A household member liable for an overpayment with an active EBT food account may request a one-time debit of the EBT food account as payment toward a SNAP overpayment claim instead of making separate recoupment payments. When this occurs OIG or HHSC Accounts Receivable staff:

  • use the EBT System to verify the:
    • status of the 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 to document the verbal authorization to repay the claim by removing benefits from the active EBT food account;
  • inform the liable household member:
    • that the amount of the one-time payment must be maintained in the EBT account until the debit is completed; and
    • that it takes approximately 14 days for the debit transaction to be completed.
    • the person will receive a receipt of the debit within 10 days of the debit transaction; and
  • submit the original of Form H1021 by:
    • Mail:
      HHSC Lone Star Business Services
      State Office
      Mail Code 2033; or
    • Fax: 512-206-5961; and
  • 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 Accounts Receivable to pay the claim.

Note: When the liable household member contacts HHSC and disagrees with the debit transaction, they may request a fair hearing to request the return of the benefits to their account.

Related Policy

Identifying Liable Members, B-753.1
Fair Hearings, B-764

 

B—763.2 Offset Expunged Benefits

Revision 19-3; Effective July 1, 2019

 

SNAP

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

 

B—764 Fair Hearings

Revision 20-4; Effective October 1, 2020

 

TANF and SNAP

When it is unclear whether the household wishes to appeal an action taken by eligibility staff or an action taken by OIG staff, eligibility staff and OIG review the request for an appeal to determine what action the household is appealing. If a household disputes the establishment of a claim or collection action initiated by OIG and requests an appeal, OIG will take the lead and begin processing the appeal. Eligibility staff must attend the hearing along with OIG if the appeal includes the eligibility staff’s action that was not part of the establishment of the claim.

Note: Form H4800, Fair Hearing Request Summary, is not used to submit an appeal request when the household disputes the establishment of a claim or action initiated by OIG. If Form H4800 is sent directly to the hearings division, it will be returned to staff with instructions to correctly submit the information.

 

OIG Staff

OIG staff use the Automated System for the Office of Inspector General (ASOIG) to submit appeal requests on claims or collection actions.  

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

Exception: When ASOIG is not available or an investigation is not found in ASOIG, OIG staff process the appeal through the TIERS Hearings and Appeal function located in the left navigation menu.

 

Eligibility Staff Working in TIERS

When a person verbally requests an appeal, process the fair hearing request by selecting the Hearing and Appeal option found on the left-navigation menu in TIERS and choose Create Appeal.

When a fair hearing request is received in writing by fax or mail, fax the appeal request, using the fair hearing cover sheet, through the expedited fax line (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 (CRU) 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.

Related Policy
Appeal Procedures, B-1030
Local Office Procedures for Hearing Requests, B-1031
Providing Form H4800-A, Fair Hearing Request Summary (Addendum), to Hearings Division, B-1031.2

 

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