OKDHS - OAC 340:65-3-4. Investigation of eligibility conditions and services planning

340:65-3-4. Investigation of eligibility conditions and services planning

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Revised 7-1-12

The worker is responsible for collecting information necessary for determining the client's eligibility for benefits and addressing the client's social services needs. When verification of information from a source other than the client's statement is necessary, the sources described in this Section are used. • 1

(1) Home visits. Home visits are sometimes necessary for Field Operations Division (FOD) Family Support Services (FSS) staff to provide services and benefits and to promote safety and stability for families. All home visits must be planned and coordinated to prevent duplication of efforts.
- (A) FOD, Adult Protective Services (APS) staff may make home visits and client contacts outside normal working hours within policy as outlined in OAC 340:5.
- (B) All other FSS workers may make home visits or other client contacts outside normal working hours when it is in the best interest of the client and approved by appropriate supervisory personnel. Home visits are made when: • 2
  - (i) there is a need to confirm the accuracy of statements and documentation cannot be obtained from other sources;
  - (ii) an office visit would create a hardship for the household;
  - (iii) a Temporary Assistance for Needy Families (TANF) case is closed due to failure to cooperate per OAC 340:10-2-2;
  - (iv) it is the best method to complete or review the employability plan;
  - (v) protective services are needed; or
  - (vi) the worker deems it necessary.
(2) Collateral contact. A collateral contact is a verbal confirmation of a household's circumstances by a person outside the household. The collateral contact may be made either in person or over the phone.
- (A) The acceptability of a collateral contact is not restricted to a particular person, but may be anyone that can be expected to provide an accurate third party verification of the household's statement. Examples of acceptable collateral contacts are:
  - (i) employers;
  - (ii) agencies, businesses, or community action groups;
  - (iii) migrant service agencies;
  - (iv) neighbors of the household;
  - (v) landlords; or
  - (vi) other persons outside the household.
- (B) The client's signature on the application or review is the necessary authorization for securing required information or verification from collateral contacts. This authorization includes the permission of the client's spouse for information regarding his or her circumstances to be given in connection with the same application or review and of the client's parents when the client is a dependent child who is blind or disabled.
  - (i) If the collateral contact requires written authorization before supplying information to the Oklahoma Department of Human Services (OKDHS), the client signs Form 08AD060E, Request for Release of Information, to give authorization.
  - (ii) When information is needed regarding another adult household member, that person may need to sign Form 08AD060E before the collateral contact agrees to release information for another adult household member.
- (C) The worker advises persons contacted for information related to the client's eligibility of how the information is used and the reason it is needed. If the person is unwilling for the client to know his or her identity, the person's name is not recorded in the case record and is not revealed to the client. • 3
- (D) When someone contacts OKDHS with information related to the client's eligibility and requests anonymity, that person's name is not recorded in the case record nor revealed to the client. • 3
- (E) The worker is responsible for discussing with the client any inconsistent information obtained from collateral contacts related to the client's eligibility. The client is given the opportunity to clear up conflicting information when possible. • 4
(3) Public records. Sources of information in the form of public records that provide essential information may be obtained without consent from any person whose transactions are involved.
(4) Data exchange. Automated data exchange with other agencies provides benefit, wage, tax information, and verification of Social Security numbers. The information obtained is electronically compared with data stored within OKDHS electronic records to determine if there are discrepancies that need to be addressed. Automated data exchange information is also available within the OKDHS system to determine discrepancies. • 5 Refer to OAC 340:65-1-2 for information regarding practices for safeguarding case information and raw tax data. The worker is responsible for:
- (A) reviewing data exchange information at the time of application and review of eligibility. Data exchange information screens available are:
  - (i) Beneficiary and Earnings Data Exchange System (BENDEX); • 6
  - (ii) Buy-In Data Exchange (BIL); • 7
  - (iii) Supplemental Security Income (SSI)/State Data Exchange System (SDX); • 8
  - (iv) Social Security Administration (SSA) Beneficiary Earnings Exchange Record (BEER/BWG); • 9
  - (v) New Hire Employee list (NHL); • 10
  - (vi) Social Security Number (SSN) Verification - SSN Enumeration; • 11
  - (vii) Wage Data Exchange; • 12
  - (viii) Unemployment compensation; • 13 and
  - (ix) Unearned Income Eligibility Verification System (IEVS) income report (IEVS-IRS) and resource data from the Internal Revenue Service (IRS); • 14
- (B) initiating appropriate queries; and • 15
- (C) resolving data exchange discrepancy messages within 45 calendar days of the date the message is posted on the data exchange inquiry screen. • 16
(5) Systematic Alien Verification for Entitlement (SAVE). All applicants and recipients of the TANF, SoonerCare (Medicaid), Supplemental Nutrition Assistance Program (SNAP), Low Income Home Energy Assistance Program (LIHEAP), State Supplemental Payment (SSP), and Child Care Subsidy Program benefits are required to declare their citizenship status. Persons who declare themselves or their minor child non-citizens must present documentation of their legal alien status from the United States Citizenship and Immigration Services (USCIS) or other acceptable source. The status, as determined from the documentation, must be verified through the Alien Status Verification Index (ASVI) maintained by USCIS. • 17
(6) Workers' compensation. Family Support Services Division (FSSD) staff reviews copies of all Workers' Compensation Court documents by matching SSNs with OKDHS records. Any court action that appears to potentially impact eligibility is forwarded to the servicing OKDHS office for clearance. A copy of the document is retained in the case record. • 18
(7) Birth verification. For persons born in Oklahoma, OKDHS has an agreement with the Oklahoma State Department of Health to verify birth electronically for persons with an open SoonerCare (Medicaid) benefit. • 19
(8) Food stamp disqualification (FSD). When a client has been disqualified for food benefits due to fraud, the FSD screen shows the date the disqualification began and the length of the disqualification period. • 20

INSTRUCTIONS TO STAFF 340:65-3-4

Revised 7-1-12

1. (a) In any program where the client fails to present complete or consistent verification, agreement must be reached between the client and the worker regarding:

(1) what questions remain;

(2) how the client can resolve or help to resolve the questions; and

(3) what actions the worker will take to resolve the questions.

(b) If the client is unwilling to help resolve the question or permit the worker to seek essential information, the worker is responsible for:

(1) discussing the information required for an eligibility determination;

(2) informing the client of the consequences for failure to cooperate; and

(3) evaluating whether facts have been presented clearly enough for sufficient understanding.

2. (a) If it is necessary for a worker to have contact with a client outside of normal working hours because of an emergency and the worker's immediate supervisor is not available, the worker must obtain authorization from the county director or designee prior to the contact, if available. If the immediate supervisor and county director or designee are not available, the worker takes care of the client's emergency need and notifies appropriate supervisory personnel of the situation as soon as possible.

(b) When social service needs are indicated, it is recommended that the client be given Publication No. 09-454, Statewide Helpline Numbers. There is space on the publication for the worker to enter information about appropriate local resources.

(c) The Address Confidentiality Program (ACP) is administered by the Office of the Attorney General to assist victims of domestic violence. The ACP prohibits state agencies from requiring an ACP participant to provide his or her finding address. If the client has an ACP authorization card, no home visit is made. When making referrals, the worker must use the ACP substitute address shown on the ACP authorization card. For more information concerning ACP refer to http://www.oag.state.ok.us/oagweb.nsf/vservices.html.

3. When a collateral contact requests anonymity, information obtained from the collateral contact cannot be used to reduce or close benefits unless the information is verified by another source.

4. (a) The worker documents in the Family Assistance/Client Services (FACS) Case Notes information obtained from collateral contacts and the client's explanation regarding inconsistencies.

(b) When the client cannot be contacted to explain inconsistencies, the worker documents in FACS Case Notes what attempts were made.

5. (a) Data exchange information is obtained by matching the client name, Social Security number (SSN), Social Security claim number, and date of birth from Oklahoma Department of Human Services (OKDHS) records with other state and federal agency records. The results of the match are posted to the Information Management System (IMS) and are viewed by using various transactions. An online description of any IMS transaction is viewed by entering M space and the transaction name. For example, M PY.

(b) PY is an index of data exchange information and case data for a particular person.

(1) To access, enter PY space and the SSN of the person being queried or enter PY space case number and person code.

(2) PY may also be accessed from the EF page of the PS-2 for the person being queried by typing PY at the bottom of that page and pressing the enter key.

(A) The upper portion of the PY screen lists records from the PS-2 database for the SSN queried.

(B) The middle portion of the screen lists records from the ALFX client database.

(C) The lower portion of the screen lists types of data exchange information available for the person.

(3) The user may also enter the PY transaction code at the bottom of any data exchange screen and return to the PY screen.

(4) Data exchange information is viewed by:

(A) moving the cursor to the line of information desired, typing in the transaction code, and pressing the enter key; or

(B) entering a transaction code and SSN of the person at the top of a blank IMS screen.

(c) DXL is a history screen of all data exchange discrepancy messages found on a particular person. The user may access this screen by entering DXL space SSN. The DXL screen lists the:

(1) type of error;

(2) found date;

(3) resolved date;

(4) system code; and

(5) comparison between case income and income shown on the data exchange system.

6. Beneficiary and Earnings Data Exchange System (BENDEX). BENDEX provides verification of Social Security benefits and Medicare entitlement. To view, enter BEN space Social Security claim number.

(1) When using BENDEX to verify Social Security benefits, drop the cents, if any, from the gross benefit amount in BENDEX Field B08 and use only the whole dollar figure. For example, round $349.50 to $349.00. Refer to (2) of this Instruction for dual entitlement information.

(2) Persons dually entitled to Social Security benefits under two claim numbers may receive one check, if the benefits are combined, or two separate checks.

(A) If the person receives a combined benefit, there will be two BENDEX records reflecting an entry of D in Field B14 and the records will be cross referenced in BENDEX Field B15. One record has a payment status code CP and the other is coded AD.

(B) The benefit issuance process used by the Social Security Administration (SSA) may cause a $1 or $2 difference in the actual payment made to a person who receives combined benefits.

(C) When using BENDEX to determine countable income for persons receiving combined benefits:

(i) subtract the gross income on the record with payment status code AD from the gross income on the record with payment status code CP;

(ii) drop the cents, if any;

(iii) drop any cents from the BENDEX record with payment status code AD; and

(iv) add the two whole dollar figures together to determine the correct countable income.

7. Buy-in data exchange (BIL). To view buy-in data for Part A and Part B Medicare, enter BIL space Medicare claim number. Refer to additional information at the OKDHS InfoNet Family Support Services Division (FSSD) Information Privacy and Security Medicare Buy-In website.

8. (a) SSI/State Data Exchange System (SDX). The SDX file contains data for Supplemental Security Income (SSI) applicants and recipients, which is viewed by entering SDX space SSN. When using SDX to verify SSI income, the worker rounds the amount shown to the nearest dollar. For example, 1¢ to 49¢ is rounded down and 50¢ to 99¢ is rounded up.

(b) SDX list (SDL). The SDL transaction is a shortcut that reduces keystrokes and provides a history list of the current and previous SDX records. To view, enter SDL space SSN. To view a particular record, move the cursor to the line of the record date selected, type SDX, and press the enter key.

9. SSA Beneficiary Earnings Exchange Record (BEER/BWG). The SSA earnings record file is accessed through the BENDEX system and is requested on all applicants. This data is from 18 to 24 months old when received. To view, enter BWG space SSN.

10. New Hire Employee list (NHL). This transaction provides information obtained from employers reporting new hires to Oklahoma Employment Security Commission (OESC). The list is in SSN order and is viewed by entering NHL space SSN.

11. SSN enumeration (ENU) transaction. When a client is required to have a SSN, but none is shown on Family Assistance/Client Services (FACS) or is shown, but not verified, ENU sends the client's information for matching with SSA records. SSA returns one of 12 possible messages to indicate the results of the match. The message is posted to ENU, G3, and PY. When the SSN is verified, ENU updates PS-2 block F42 with Y. Refer to detailed information at the OKDHS InfoNet FSSD Information Privacy and Security Social Security Number Process website.

12. Wage Data Exchange (OWG). Information received from OESC is compared to case data. Discrepancies are posted to the G1DX screen. The worker contacts the client or employer to confirm the employment, wages earned, and available medical insurance information on the employee and dependents. To view, enter OWG or OWC space SSN.

13. Unemployment Compensation (UIB). A computer match is made weekly of OKDHS cases in active or application status with Unemployment Insurance Benefits (UIB) files. To view, enter UIB space SSN.

14. Unearned Income Report (IEV). Internal Revenue Service (IRS) matched records are viewed by using the IEV transaction. Additional information, such as the payer's address and a brief explanation of the document type code, are available by using the WGD transaction. Both transactions may also be accessed on any segment line of the PY transaction. A glossary of document code definitions may be viewed on the mailbox transaction IEV.

15. Online query transactions available on IMS for requesting specific types of data on a person are:

(1) Oklahoma Wage Link (OWL). The OWL transaction is an online query with the OESC which lists the last two quarters of employment and current UIB information. This transaction MUST be used at initial application and reviews. To request information, enter the transaction OWL space person's SSN;

(2) Quarters covered (QTRC/QTRI). The QTRC transaction is used to query the SSA earnings file for a determination of covered quarters of employment. When requesting the information, enter the transaction QTRC space SSN.

(A) The worker enters identifying information about the person on the screen and presses enter.

(B) After a confirmation screen appears, the worker presses the enter key a second time to release the query. Normally, the response is returned in two to three days and displayed on the QTRI screen.

(C) To access the data, the worker enters QTRI space SSN or by using the PY screen. When using PY, move the cursor to the line marked QTR, type in QTR, and press the enter key. This screen displays the number of covered quarters for the person as well as other information.

(D) If information is not returned after three business days, re-initiate the request; and

(3) Third Party Query (TPQYC/TPQYI). Verification of SSI, Social Security cash benefits, Medicare, and the person's SSN may be obtained through the automated Third Party Query procedure. This procedure accesses the same file that produces SDX and BENDEX data. A SSA verification record may also be requested by using the TPQYC transaction.

(A) To access this online transaction, type TPQYC, space, and case number, enter the SSN when prompted, and confirm the information entered.

(B) If no response is received within 48 hours of the request, repeat the process.

(C) The TPQYC transaction generates online data which is returned to the requester electronically.

(i) Information verified with this procedure is generally the most current since Social Security records may be updated at various times during any given month. Therefore, data on TPQYC responses may or may not agree with data appearing on the SDX or BENDEX file for the same person.

(ii) To view the returned data, enter TPQYI space SSN or use the TPQ transaction code while on the PY screen. A detailed explanation of this procedure is available on the Family Support Services Division (FSSD) Information Privacy and Security Web page by clicking IMS Transactions and then Special Processes.

(iii) When using TPQYC to verify:

(I) Social Security benefits, the gross benefit amount is shown as a rounded down whole dollar figure; or

(II) SSI income, net amounts are given. This figure is rounded to the nearest dollar. For example, 1¢ to 49¢ is rounded down and 50¢ to 99¢ is rounded up.

16. Data exchange information is routinely compared with OKDHS records. When discrepant information is detected, an automated system of notification posts discrepancy messages to IMS. These messages are accessible by using transactions G1DX, G3, and PY. All discrepancy messages must be cleared using the DXD transaction within 45 calendar days of the error posting.

(1) G1DX displays a list of discrepancy messages by OKDHS office that is accessed by entering G1DX space OKDHS office number and location code. A more detailed list is obtained by entering G1DX space, OKDHS office number, location code, supervisor number, and district number.

(2) G3 displays an expanded message. The user accesses this screen by entering G3 space case number.

(3) DXD is used by the worker to clear the data exchange discrepancy after the information has been documented and appropriate action taken. The user accesses this screen by entering DXD space case number. When the screen appears, the user is prompted to enter his or her SSN, system type, and a reason code representing whether the error caused a reduction (reason code 7), an increase (reason code 9), or no change in benefits (reason code C). After pressing the enter key, confirmation is requested. If Y is selected, the transaction clears the error from G1DX and G3 and posts a resolution date on the DXL screen.

17.(a) The Alien Status Verification Index (ASVI) is accessed through a Web-based online system at https://www.vis-dhs.com/WebOne/vislogin.aspx?JS=YES using a Web form. Online responses are returned for the initial verification inquiry and/or the additional verification inquiry. For case documentation, the online verification number or entire verification record is printed and filed in the case record or copied and pasted into FACS Case Notes.

(1) Initial verification responses are returned in three to five seconds. Initial verification is initiated if at least one of the documents in (A) through (J) of this Instruction appears to be valid, is available, and has an A-number of A0000001 through A59999999, A70000000 through A79999999, or A90000000 through A9999999.

(A) I-551;

(B) I-151;

(C) AR-3A;

(D) I-688, I-688A, I-688B;

(E) I-689;

(F) I-766;

(G) I-327;

(H) I-571;

(I) I-181a, less than one year of age; or

(J) I-94, endorsed, in a foreign passport, less than one year of age.

(2) Additional verification is initiated on the same website as the Initial Verification or, manually, by submitting United States Citizenship and Immigration Services (USCIS) Form G-845, Documentation Verification Request. The website method is preferred since a response will be returned in three federal business days as opposed to receiving a paper response on Form G-845 within ten business days. Benefits of persons who are otherwise eligible are not delayed, terminated, or reduced due to the non-receipt of a response from USCIS. Additional verification rather than initial is initiated immediately when:

(A) documents that appear counterfeit or altered are presented;

(B) there is no A-number on any document;

(C) an A-number in the A60000000 or A80000000 series appears on any document;

(D) any USCIS fee receipt other than I-689 is presented; or

(E) Form I-181a or I-94 in a foreign passport has the endorsement "Temporary Evidence of Lawful Admission for Permanent Residence" processed more than one year ago.

(b) USCIS is responsible for determining immigration status. FSSD reports to USCIS the names and addresses of applicants or recipients who are determined to be residing in the U.S. unlawfully. The worker reports to FSSD the names and addresses of applicants or recipients who:

(1) admit illegal aliens are present in the household and present USCIS information that appears to be forged; or

(2) present a formal order of deportation or removal.

18. Any case action taken is documented under Case Notes in FACS.

19. The availability of new birth records within a previous five month period is dependent upon reporting time frames of hospitals, midwives, and birth centers. When a data match occurs, the system updates the "citizenship verification" and "citizenship verification date."

20. To display the FSD screen, enter FSD space SSN.

(1) The FSD is indicated on the PY screen so a separate transaction is not necessary if the PY transaction is used first.

(2) When fraud has been determined for the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) this information is updated on the FSD screen.

(3) For SNAP rules, refer to OAC 340:50-15-25 and 340:65-9-4 for TANF Program rules.

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