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CHAPTER 125. APPLICATION PROCESS
GENERAL PROVISIONS Sec.
125.1. Policy.
TANF/GA PROVISIONS FOR THE
APPLICATION PROCESS
125.21. Policy.
125.24. Procedures.
MA PROVISIONS FOR THE APPLICATION PROCESS
FOR THE CATEGORICALLY NEEDY
125.74. Procedures.
MA PROVISIONS FOR THE APPLICATION PROCESS
FOR THE MEDICALLY NEEDY
125.84. Procedures.Cross References This chapter cited in 55 Pa. Code § 123.22 (relating to definitions); 55 Pa. Code § 140.145 (relating to notice and appeal rights for MA applicants); 55 Pa. Code § 140.221 (relating to conditions of eligibility); 55 Pa. Code § 140.311 (relating to verification requirements); 55 Pa. Code § 140.603 (relating to conditions of MA eligibility); 55 Pa. Code § 140.721 (relating to conditions of eligibility); 55 Pa. Code § 141.21 (relating to policy); 55 Pa. Code § 141.41 (relating to policy); 55 Pa. Code § 141.61 (relating to policy); 55 Pa. Code § 141.71 (relating to policy); 55 Pa. Code § 165.43 (relating to requests for special allowances for supportive services and time frames for eligibility determinations); 55 Pa. Code § 183.91 (relating to LRR, parent or legal guardian of an AFDC minor parent and stepparent deductions); 55 Pa. Code § 183.103 (relating to additions to the budget group); and 55 Pa. Code § 183.104a (relating to additions to or deletions from a budget groupstatement of policy).
GENERAL PROVISIONS
§ 125.1. Policy.
(a) General. Application is made on an application form approved by the Department.
(b) Identification. At the application interview, an applicant shall present proof of identity using documents such as a Social Security Card, drivers license, selective service card, voter registration card, a Departmental identification card or a work or school I.D. If documentary proof of identification is not readily available, the worker shall attempt to verify the applicants identity through a collateral contact. Examples of acceptable collateral contacts include social service agencies, landlords, employers, neighbors and others who can be expected to provide accurate third-party verification.
(c) Referral to the domestic relations section of the court. To receive benefits for himself, an applicant applying on behalf of a child whose eligibility is based on deprivation due to absence of a parent from the home shall be referred to the domestic relations section or other applicable division of the court of common pleas unless the applicant is claiming good cause as specified in Chapter 187 (relating to support from relatives not living with the client). The caretaker relative may still apply for and receive benefits for eligible minor children without completing the referral process.
(d) Signing of application form. Requirements for signing of an application form are as follows:
(1) The applicant, regardless of age, shall sign prior to filing the form and again during the application interview.
(2) Persons applied for who are 18 years of age or older and emancipated minors 17 years of age or younger shall sign during the application interview or within 30-calendar days from the date of authorization.
(3) Failure to sign shall result in the ineligibility of the person required to sign the form.
(e) Signing of authorization to release information form. Under § 201.4 (relating to procedures), the applicant or the person who is the payment name, regardless of age, and individuals applied for or receiving cash assistance who are 18 years of age or older and emancipated minors 17 years of age or younger shall sign the form. Failure to sign shall result in ineligibility of the person required to sign the form.
(f) Signing an agreement of mutual responsibility. Each applicant for and recipient of cash assistance and other individuals who are required to sign an application for assistance shall sign an AMR, as defined in § § 123.22 and 165.2 (relating to definitions; and definitions) that must be signed and approved by the CAO.
(g) Failure to sign or complete AMR. An individual who is required to sign an application for assistance who fails, without good cause, to sign or cooperate in the completion of an AMR is ineligible for cash assistance until the individual completes and signs an application and approved AMR.
(h) Failure to comply with AMR.
(1) Failure of the individual to cooperate with child support requirements, without good cause, will result in the penalties described in § 141.21(e) (relating to policy).
(2) Willful failure to comply with RESET participation requirements, without good cause, will result in the penalties described in § 165.61 (relating to sanctions).
(3) Failure to comply with other aspects of the AMR, without good cause, will result in ineligibility for cash assistance until the individual complies.
(i) Contents of AMR. An individuals obligations set forth in the AMR include:
(1) Remain free of alcohol and illegal drugs if substance abuse is determined to be a barrier to employment.
(2) Participate in, maintain compliance with, and satisfactorily complete a drug and alcohol treatment program approved by the Department of Health or administered by an agency of the Federal government, or both.
(3) Provide timely and accurate information.
(4) Cooperate in establishing paternity and obtaining support as specified in § 187.23 (relating to requirements).
(5) Seek and participate in an educational program leading to a high school diploma or its equivalent, job training or work-related activities.
(6) Seek, accept and maintain employment.
(7) Accept referral to, participate in and continue to participate in an available work-related activity, if applicable, including work-related activities specified on the AMR.
(8) Accept referral to, work in and retain employment in which the individual is able to engage and participate in work activities specified on the AMR.
(9) Not reduce earnings without good cause.
(10) Obtain prenatal care, if applicable.
(11) Maintain the health and well being of the individuals children, including the following, if applicable:
(i) Ensuring that children attend school and pursue a high school diploma or its equivalent.
(ii) Ensuring that children receive immunizations, appropriate health screenings and necessary medical treatment, consistent with Nationally recognized standards.
(iii) Performing other appropriate activities based on an assessment of the education level, parenting skills and history of parenting activities and involvement of each parent who is applying for assistance.
(j) Approved work and work-related activities. The specific work and work-related activities approved for the individual are included on the AMR.
(k) Notice. A notice approved by the Department is sent to the applicant whenever a decision is made on the eligibility of the applicant or person for whom he is applying.
Authority The provisions of this § 125.1 amended under sections 201(2), 403(b), 405, 405.1, 405.3 and 432 of the Public Welfare Code (62 P. S. § § 201(2), 403(b), 405, 405.1, 405.3 and 432); the Support Law (62 P. S. § § 19711977); Titles I and III of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Pub. L. No. 104-193) (PRWORA), creating the Temporary Assistance for Needy Families (TANF) Program, and amending 42 U.S.C.A. § § 601619, 651669(b) and 1396u-1; section 5543 of the Balanced Budget Act of 1997 (Pub. L. No. 105-33) (42 U.S.C.A. § 653(p)); the Federal TANF regulations in 45 CFR 260.10265.10; and the Domestic Relations Code, 23 Pa.C.S. § § 43014381, 5103, 71017901 and 81018418.
Source The provisions of this § 125.1 amended through July 16, 1982, effective July 17, 1982, 12 Pa.B. 2286; amended October 4, 1991, effective October 5, 1991, apply retroactively to November 1, 1989, 21 Pa.B. 4643; amended September 13, 2002, effective retroactively to March 3, 1997, 32 Pa.B. 4435. Immediately preceding text appears at serial pages (268481) and (268482).
Cross References This section cited in 55 Pa. Code § 133.23 (relating to requirements).
TANF/GA PROVISIONS FOR THE APPLICATION PROCESS
§ 125.21. Policy.
(a) Client as the primary source of information. The client will be the primary source of information in establishing eligibility for cash assistance. In establishing his eligibility, the client shall be required to substantiate the information the applicant has provided by documentary evidence or other means as may serve to establish the truth of the applicants statements.
(b) Verification. Conditions of eligibility, need, which includes need for special need allowances, and resource items will be verified at the application interview and prior to authorizing cash assistance and at the time of each redetermination, complete or partial, as specified in Chapter 133 (relating to redetermining eligibility).
(1) If necessary verification is pending from a third party including certification of cooperation from the Domestic Relations Section of the Court of Common Pleas and the client has cooperated in the verification attempt, initial authorization of cash assistance will not be delayed more than 30-calendar days from the date of receipt of a completed, signed application.
(2) Verification subsequent to authorization shall be provided within 30-calendar days following the authorization date. If the client is cooperating in the verification attempt and the delay in securing the information is due to a third party, assistance will continue until documentation is secured. Cooperation and progress on securing the documentation shall be reassessed every 30-calendar days.
(c) Disclosure. It shall be a condition of eligibility for cash assistance that an applicant or recipient disclose information about the age, residence, citizenship, employment, income and resources of the applicant or recipient and consent to the disclosure of the information which is in the possession of third parties.
Authority The provisions of this § 125.21 issued under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. § § 201(2) and 403(b)).
Source The provisions of this § 125.21 amended July 16, 1982, effective July 17, 1982, 12 Pa.B. 2286; amended October 4, 1991, effective October 5, 1991, apply retroactively to November 1, 1989, 21 Pa.B. 4643; amended July 28, 2000, effective retroactive to June 17, 1996, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (266093) to (266094).
Notes of Decisions Primary Source of Information
If a recipient denies being married but in her request for a hearing and at the hearing she concedes her marriage but questions its validity, she has not given sufficient information to establish eligibility, especially in light of her obligation to substantiate her claim by documentary evidence or such other means as may serve to establish the truth of her statements. Neal v. Department of Public Welfare, 413 A.2d 1195 (Pa. Cmwlth. 1980).
The client was properly denied benefits since she failed to return the information forms concerning the income available to her legally responsible relatives. Dempsey v. Department of Public Welfare, 404 A.2d 1373 (Pa. Cmwlth. 1979).
Substantial Evidence
Testimony of the recipient, her son, and her daughter as to the fact that recipients husband did not reside in the household, coupled with evidence of the husbands repeated denials of residence with recipient, constituted substantial evidence such that the Secretarys reversal of a determination of the Hearing Examiner that recipients benefits should be reinstated was in turn reversed by the court. Augelli v. Department of Public Welfare, 468 A.2d 524 (Pa. Cmwlth. 1983).
Cross References The provisions of this § 125.24 issued under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. § § 201(2) and 403(b)).
Source The provisions of this § 125.24 amended July 16, 1982, effective July 17, 1982, 12 Pa.B. 2286; amended April 8, 1983, effective April 9, 1983, 13 Pa.B. 1259; amended October 4, 1991, effective October 5, 1991, apply retroactively to November 1, 1982, 21 Pa.B. 4643; amended July 28, 2000, effective retroactive to June 17, 1996, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (266094), (252515) to (252518) and (267367).
Notes of Decisions Responsibility for Reporting Changes
Overpayments paid to an illiterate recipient who was receiving Social Security payments in addition to AFDC benefits were not due solely to administrative error, since the recipient admitted that she knew that when she received the Social Security payments she would be ineligible for AFDC payments. Sease v. Department of Public Welfare, 399 A.2d 1175 (Pa. Cmwlth. 1979).
Screening Interview
Although public assistance applicant obtained required verifications and delivered them to County Assistance Office same day as prescreen interview, applicant was not entitled to assistance for period between pre-screen interview and application interview since authorization as of date of application interview complied with 15 day limit of 55 Pa. Code § 125.24(c)(7)(v) and the relevant Federal law and regulation. Vazquez v. Department of Public Welfare, 504 A.2d 405 (Pa. Cmwlth. 1986).
Since the caseworker was aware of the recipients eligibility for the allowance for medical transportation expenses, the caseworker was required under 55 Pa. Code § 125.24(b)(2) to inform the recipient of the availability of such allowance, even though such information was available in the county office newsletter. Scott v. Department of Public Welfare, 400 A.2d 1350 (Pa. Cmwlth. 1979).
Cross References This section cited in 55 Pa. Code § 121.3 (relating to requirements); 55 Pa. Code § 133.24 (relating to procedures); 55 Pa. Code § 142.23 (relating to requirements); 55 Pa. Code § 168.71 (relating to monthly payment determination); and 55 Pa. Code § 255.4 (relating to procedures).
MA PROVISIONS FOR THE APPLICATION PROCESS
FOR THE CATEGORICALLY NEEDY
§ 125.74. Procedures.
(a) Responsibility for reporting changes. With the exceptions of the conditions stated in paragraphs (1) and (2), general intake procedures relate to categorically needy, NMP clients. An applicant and recipient must report all of his resources and, to the best of his knowledge, the resources of the following persons:
(1) Those living with him, that is, his spouse as defined in § 183.64 (relating to income averaging) and children under 21 years of age.
(2) Those not living with him, that is, his spouse.
(b) Additional reports. An individual applying for NMP on behalf of another person shall report the resources of the other person. An adult applying for NMP on behalf of a child under 21 years of age shall report the resources of the child.
Source The provisions of this § 125.74 amended April 27, 1979, effective August 30, 1978, 9 Pa.B. 1401. Immediately preceding text appears at serial pages (38948).
MA PROVISIONS FOR THE APPLICATION PROCESS
FOR THE MEDICALLY NEEDY
§ 125.84. Procedures.
(a) Origin of an application. The following shall apply to the initiation of an application:
(1) The application process will begin when a person indicates to the County Office by any action that he wants his MA eligibility determined.
(2) An application may be made prior to the need for service or at the time the need for service arises.
(3) An application will not be accepted on behalf of a person who has died, in accordance with § 123.82 (relating to definitions).
(4) An application for MA may be made in person, by letter or by telephone.
(5) If because of illness, infirmity or a physical or mental handicap a person is unable to apply for himself, a relative, a friend or official of the institution or agency providing the service may apply on behalf of the applicant.
(6) If the applicant has a guardian or other legal representative, that person shall be expected to apply on behalf of the applicant if he is available to do so.
(7) Regardless of the way an application for MA is made, the county office will follow it up promptly with appropriate action to decide whether or not the applicant is eligible.
(b) Place of application. The place of application shall conform with the following:
(1) Normally, application is made to the county office in the county of residence. However, if the care is being furnished in another county, application may be made in that county.
(2) If the person is not a resident of the county in which application is being made, the completed application forms will be sent to the county of residence, which will complete the determination of eligibility. A person who is institutionalized for other than inpatient hospital care will be considered a resident of the county in which the institution is located.
(3) If a resident is out of this Commonwealth and a request is received, the necessary forms will be sent for completion to the institution providing the care and, upon their return, eligibility will be determined and disposition made.
(c) Personal interview required. A personal interview with an applicant is required. The required interview will be held within 60 days from the date the application, Form PA 743 is received in the County Assistance Office. Pending the interview, MA may be authorized for no more than 60 days on the basis of the information in the application, as set forth in § 127.84 (Reserved). At the time of the personal interview, a Form PA-743R will be completed by the County Assistance Office worker and signed by the applicant. If information gained at the personal interview for Page 1, Form PA-743R, differs from the information on Page 1, Form PA 743 taken at application, the clerical unit must submit the new information to the Bureau of Data Processing via Form PA-743RE.
(d) Purposes of the interview. The purposes of the interview are as follows:
(1) Review and evaluate the application form for accuracy and completeness.
(2) Inform the applicant of additional information or substantiating information needed to determine eligibility or category.
(3) Explain to the applicant his rights and responsibilities and obtain the signature of the applicant on the Form PA-743S (Rights and Responsibilities).
(4) Inform the applicant of the medical services available to him.
(5) Discuss with the applicant any other information or regulations that are pertinent to his situation.
(6) Witness the signature of the client.
(7) Complete a Form PA-743R and obtain the signature of the client on it.
(e) Disposing of an application. Applications will be disposed of as follows:
(1) Applications will be promptly acted upon and eligibility will be determined as quickly as possible, preferably within at least 30 days from the date of application appearing on the Form PA 743. If circumstances are such that the County Office is unable to make a decision within the 30 day period, it may extend this period on condition that the applicant is advised, by letter, of the reasons for the delay, the date he may expect a decision, and his right to a fair hearing if he believes the delay is unjustified.
(2) The application process will end, and the application be disposed of, when one of the following has taken place:
(i) The applicant is found to be eligible.
(ii) The applicant is found to be ineligible.
(iii) The applicant withdraws or fails to complete the application.
(3) However, after the applicant has sworn to and signed the affidavit, and service under the program has been received, the application may not be withdrawn. The worker will record the decision and the supporting evidence in the case record.
Notes of Decisions Denial of Application
It was appropriate for the County Assistance Office to turn down applicants Medical Assistance application when her husband refused to substantiate information about his income. Stanley v. Department of Public Welfare, 535 A.2d 674 (Pa. Cmwlth. 1987).
Disposition of an Application
A nursing homes argument that if the application for Medical Assistance eligibility had been acted upon within 30 days rather than 9 months, it easily could have submitted its invoice for payment of services within the 180-day period allowed, was without merit, where subsection (e)(1)s preference for quick determinations does not rise to the level of a legal obligation, and there was no evidence presented that the Department of Public Welfare contributed unnecessarily to the delay, apart from the bare observation that the eligibility determination took a long time. Ashton Hall, Inc. v. Department of Public Welfare, 743 A.2d 529 (Pa. Cmwlth. 1999).
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