11120 Overpayments and Claims - An overpayment is assistance that is over the amount to which the client is entitled.
One or several months of overpayment become a claim when the cause of the overpayment(s) are due to the same or related causes. See 11121. A claim shall be established against any household that has received more assistance than it is entitled to receive, except as outlined in 11122.
For food assistance, all adult household members shall be jointly and separately liable for the amount of any overpayment of benefits to the household. For cash (including the Work Incentive payment), any or all of the adult members of an assistance family group in which an overpayment occurred are liable for the overpayment and recovery efforts can be established on any of these adult members. For non-refugee non-citizens, both the non-citizen's sponsor and the non-citizen are liable for any overpayment made to the non-citizen.
11121 Criteria For Establishing Types of Claims - Claims are classified according to the error cause as follows:
11121.1 Agency Error - Instances of agency error which may result in a claim include, but are not limited to, the following:
Prompt action was not taken on a change reported by the household;
The household's income or deductions were incorrectly computed or the household was otherwise assigned an incorrect allotment;
Benefits continued to be provided to a household after its review period had expired without benefit of a reapplication determination; or
Misapplication of policy.
11121.2 Client Error - Instances of client error which may result in a claim include, but are not limited to, the following:
11121.3 Fraud Error - A fraud error is a willful client error which has been found to be fraud in accordance with the provisions in 11200. An individual shall be considered to have committed fraud for TANF (including the Work Incentive payment), Child Care, and Food Assistance:
Fraud error status is not established if a court's resolution to a willful error situation is to place the person on diversion unless the person has signed a disqualification consent agreement. Potential fraud claims are initially established as a recovery account with a status reason of ‘Pending Fraud Prosecution.’ Also see 11125.
See 11220 for penalties applicable to fraud determinations.
NOTE: The proper classification of cash overpayments is critical for determining the correct amount of Food Assistance benefits when reduction is being made from a cash assistance payment for overpayment recovery. See 6410.
11122 Instances Not Requiring a Claim - A claim shall not be established if an overpayment occurred as a result of the agency failing to insure that the household fulfilled the following procedural requirement :
Signed the application;
Other instances when a claim should not be established include:
11123 Time Frames and Limits for Establishing Claims - The date of discovery for purposes of tracking timely claims establishment (based on the following time frames) shall be the date the case is first identified as potentially having an overpayment either by the worker, quality control or by other means.
Time Frames
For agency and client overpayments, the agency is required to prepare the claim and initiate recovery or attempt to initiate recovery by the end of the calendar quarter following the calendar quarter in which the overpayment is first identified.
Note: Failure to establish a claim within the time frames identified does not negate the responsibility of agency to establish or collect on the claim, or of the client to repay any benefits they received but were not entitled to.