Food and Nutrition Services FSs835

FS 835 Report of Erroneous Issuance (DSS-1682)

Change #2-2010

June 1, 2010

835.01 GENERAL POLICY

Complete the DSS-1682, Report of Erroneous Issuance for a Food and Nutrition Services (FNS) claim or restored benefits. File the form and supporting verification in the claim file and/or certification file.

835.02 INSTRUCTIONS FOR ENTRIES ON DSS-1682

Item 1: Complete all information. The date of discovery is the date you became aware of sufficient facts or evidence that lead to a conclusion that an erroneous issuance took place.

Item 2: Check whether the claim is a recipient claim (overissuance) or a restoration of lost benefits (underissuance).

Item 3: Check the appropriate category of claim. Use code “U” for suspected intentional program violation (IPV) cases pending an administrative hearing. Use code “P” for suspected IPV cases pending court action. EPICS does not accept payments on “U” or “P” categories. Codes A, H, V, and S are self-explanatory.

Item 4: Check the method used and date the IPV is established. The method is not determined until the IPV is established. The codes are self-explanatory. Enter the date of the action or decision.

Item 5: Enter the “From” and “To” month and year for the periods of erroneous issuance.

Item 6: Check the appropriate block.

Item 7: Summarize the circumstances of the case. Attach a separate sheet if needed. Include:

a. The source of discovery for each period of erroneous issuance;

b. The cause of the overissuance, including the reporting status, if applicable;

c. Documentation of the first month of overissuance including unreported or incorrect information at application or recertification, 10-10-10 or 10-10 or 10^th-10-10 dates; and

d. The category of the claim.

e. Any other pertinent information that was used to determine the claim amount.

Attach copies of any related correspondence or documents.

Item 8: Enter the information required for each period of erroneous issuance.

Item 8a: Date Certified – Enter the date the IMC keyed the DSS-8590 to certifiy the case.

Item 8b: Date Issued – Enter the date the allotment was issued. Use SLII to verify participation.

Item 8c: HH Size (Actual) – Enter the household size used to issue the allotment to the FNS Unit.

Item 8d: HH Size (Correct) – Enter the household size used to determine the correct issuance. Include all individuals eligible to be included in the FNS Unit.

Item 8e: HH Type (Actual) - Complete with the classification PA, AFS, or NA, as appropriate.

Item 8f: HH Type (Correct) – Complete with the correct classification PA, AFS, or NA, as appropriate.

Item 8g: Actual Income Used - Enter the gross and net income amounts used by the caseworker to issue benefits to the FNS Unit.

Item 8h: Correct Income - Include the countable income and allowable deductions of disqualified and certain ineligible individuals. Enter the gross income and net income from the SLAW calculation. If the household is over the gross limit, the net is not applicable. Enter NA in the net column.

Item 8i: Allotment Received - The allotment entered is the entitlement before any allotment reduction. SLII and issuance records used to verify participation will show the allotment the household received after the allotment reduction.

Item 8j: Correct Allotment – Enter the amount of benefits for which the FNS Unit was eligible. If the household was ineligible, enter zero on the line.

NOTE: For claims, use only the months of overissuance. For the months of underissuance, always enter zeros on the DSS-1682 in the allotment received and correct allotment columns.

For restored benefits, enter the allotment received and correct allotment as indicated. Include underissuances due to agency errors. The amount in the overissuance/underissuance column will be a negative amount to indicate an underissuance.

Item 8k: Overissuance/Underissuance – For claims, enter the amount of the overissuance. For restorations, enter the amount of the underissuance.

Item 9: Enter the values from the appropriate totals from Items 8i, 8j. and 8k. Restore benefits when the total of column 8k is negative. A claim is appropriate when the total in column 8k is positive. Enter the overissuance amount from this line in the OVERPAYMENT AMOUNT field on the CLAIM DETAIL screen in EPICS. Adjust the claim by the amount of any expunged benefits per instructions in Sections 810, 815, or 820. Complete the computation to determine the net result.

Sign and date the report in the space provided. The date signed should be the same date the claim is entered into the EPICS system. The immediate supervisor or the director or designee must review and sign the report to ensure its completeness and accuracy. It is important that all claims are reviewed by a second party.