REDETERMINING ELIGIBILITY PROVISIONS FOR TANF/GA
§ 133.23. Requirements.
(a) Reapplication. A reapplication or complete redetermination of eligibility shall conform with the following:
(1) General requirements. General requirements are as follows:
(i) A complete redetermination is a comprehensive review of eligibility factors which are subject to change, to determine continued eligibility of the budget group members. When eligibility for assistance is based on deprivation of support due to the absence of a parent, each caretaker, as provided in § 141.21(c) (relating to policy), with whom the child is living shall comply with the support requirements in § 187.23 (relating to requirements) as a condition of continued eligibility of the caretaker for cash assistance.
(ii) A reapplication form approved by the Department shall be completed in its entirety by the payment name at each reapplication interview.
(iii) The client, regardless of age, who is the payment name for the budget group shall complete and sign the reapplication form prior to or during the reapplication interview and provide the information necessary for the completion of the redetermination as a condition of continued eligibility for cash assistance. Recipients who are 18 years of age or older and emancipated minors 17 years of age or younger shall sign the reapplication form during the reapplication interview or within 15 working days of the interview date. Failure to sign shall result in ineligibility of the person required to sign the form.
(iv) The client shall consent to the disclosure of information by third parties to the CAO for the purpose of verifying the clients residence, citizenship, employment, applications for employment, income and resources as a condition of the clients continued eligibility for assistance under verification procedures in § 201.4 (relating to procedures).
(v) A complete redetermination is required as often as appropriate to the individual budget but at least as frequently as the following:
(A) Every 6 months for TANF budgets not required to report monthly.
(B) Every 12 months for TANF budgets required to monthly report.
(C) Every 12 months for GA budgets.
(vi) The worker and the recipient or other individual will review and assess the progress in achieving self-sufficiency, including compliance with the responsibilities and obligations contained in the existing AMR. As necessary, the AMR will be modified.
(vii) A recipient or other individual who signs a new or modified AMR that is approved by the Department shall comply with the obligations and responsibilities including approved work and work-related activities specified on the AMR in accordance with § 125.1(i) (relating to policy).
(viii) A recipient or other individual who fails or refuses, without good cause, to sign or cooperate in the completion of an AMR or who fails, without good cause, to comply with the AMR shall be subject to the penalties described in § 125.1(g) and (h).
(2) Items subject to review. A redetermination shall conform with the following:
(i) Within the established limits, the decision on how often to redetermine eligibility will vary with a budget depending upon the possibility of change in eligibility.
(ii) In the redetermination of eligibility, the worker shall make a finding as to whether the client who is the payment name wants assistance to continue, what plans the client may have or be developing for self-support or self-care and when the plans may mature. This redetermination shall include at least one interview with the person who is the payment name for the budget group. If the client wants assistance continued, the worker shall redetermine those eligibility factors which are subject to change. The redetermination shall include a review of the need and resource items and verification of items subject to change:
(A) Household and family composition.
(B) Income, earned and nonearned, including income-in-kind.
(C) Income expense deductions.
(E) Special need items.
(F) Employability status.
(G) Activity in seeking work or training.
(H) Employment and training program participation status.
(I) Prior applications for Social Security numbers if not yet reported to the CAO.
(J) Plans for the continuing care of a TANF child who is temporarily not residing with a specified relative.
(K) Income of individuals residing with the budget group, income of an LRR residing elsewhere and income of sponsors of aliens as determined under § § 183.34, 183.35 and 183.91183.93, if applicable.
(L) Criteria that establish GA categorical eligibility.
(3) Verification. Requirements for reapplication are as follows:
(i) For TANF and GA budget groups, verification of the items of need and resources in paragraph (2) is required at the time of reapplication. The maximum time lapse for the client to provide needed verification is 15 working days following the reapplication interview, except for verification of incapacity or disability. Verification of incapacity or disability shall be provided within 30-calendar days following the reapplication interview. 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. As a condition of eligibility for assistance, the recipient shall give consent to the CAO worker to contact third parties to secure verification of the eligibility factors in paragraph (1)(iv). Except in cases of suspected fraud, the CAO worker shall attempt to notify the client prior to contacting a collateral source for the purpose of verifying information about the client under verification procedures in § 201.4.
(ii) Verification of the individual clients accumulated personal property, including exempt property, as set forth in § 177.21 (relating to personal property), is required at reapplication. The current value of nonexempted personal property, as set forth in § 177.24(1) (relating to determining value of resources), shall be verified at each reapplication.
(iii) Those factors of eligibility already verified and not likely to change, such as birthdate, may not be reviewed unless there is something to indicate that a change may take place or has taken place. Social service needs and plans shall be reevaluated. The worker shall discuss with the client plans for the next interview and the clients responsibility to report changes.
(b) Partial redetermination. Partial redetermination procedures are as follows:
(1) A partial redetermination is a review that focuses on specific eligibility factors and need and resource items.
(i) A partial redetermination is required as frequently as indicated by the budget group circumstances, and is always conducted if previously unreported income is first discovered by a quarterly wage match.
(ii) When the partial redetermination focuses on address changes or a change in income or resources, a face-to-face interview is not required if, in the judgment of the worker, the credibility and reliability of the client are such that the clients statements may be accepted. In these instances, the redetermination may be made by telephone or correspondence. If the redetermination is made by telephone or correspondence, verification shall be submitted subsequently by the client.
(iii) When the partial redetermination focuses on an eligibility determination for Extended TANF, as defined in § 141.52 (relating to definitions), the CAO will update the existing Agreement of Mutual Responsibility (AMR) as defined in § 165.2 (relating to definitions) or complete a new AMR. The redetermination may be conducted by telephone or in a face-to-face interview. If the redetermination is completed by telephone, the CAO will send a copy of the updated or new AMR to the client. The client shall sign and return the AMR to the CAO. The AMR must be received by the CAO within 30 days of the CAO signature on the AMR. If the AMR is not received within 30 days, the client shall be ineligible for Extended TANF.
(2) A partial redetermination for budget groups in which there is an employable person shall focus on employment, employment efforts, income and resources. A partial redetermination relating to employment and employment efforts requires a personal interview which can be conducted by telephone. A face-to-face interview is not required.
(3) However, when the partial redetermination involves a loss or decrease in income in which a monthly assistance payment increase is requested or indicated, verification of the change in income is required. If verification is not available immediately, the monthly assistance payment may be increased without verification only if facts presented by the payment name are consistent and reasonable and a definite plan is made to obtain the needed verification. A monthly assistance payment increase without verification of the change in income is made only with the approval of a supervisor. The maximum lapse of time to obtain the verification is no more than 15 working days following the effective date of the monthly assistance payment increase.
(4) In addition to the provisions of this section, action will be taken promptly, but within 10-calendar days, in all cases to review pertinent eligibility factors if one of the following occurs:
(i) The client or someone on his behalf reports changes in circumstances to the agency or requests a special need allowance.
(ii) The agency learns of changes from a responsible source or the worker himself knows a change was anticipated.
(iii) Changes in the regulations of the Department make a redetermination necessary.
(iv) The payment name or someone on his behalf requests the addition of a mandatory budget group member, other than a newborn child, to the budget group. The payment name shall complete and sign a form approved by the Department and provide information only on the individual being added and on changes, financial or nonfinancial, in the budget groups circumstances. The added member, other than a newborn child, shall comply with § 201.4(a)(2)(ii).
(v) The addition of a newborn child to an open budget group as follows:
(A) Cash assistance benefits for a newborn child whose caretaker/relative is an open budget group will be authorized effective with the date of birth based solely on the notification of birth if notification occurs during the grace period. The grace period begins with the date of the childs birth and ends on the first day of the second month following the month of the childs birth or the mothers release from the hospital, whichever is later. Notification of birth includes an oral or written statement, by the caretaker/relative or a representative, made to the CAO, that the child has been born, or receipt by the CAO of the MA newborn eligibility form for the child.
(B) The CAO shall follow the common application system procedures when adding a newborn child to a cash budget group. The caretaker/relative shall file an updated common application form regarding the child and comply with necessary eligibility factors related to the childs eligibility by the end of the grace period. If the caretaker/relative fails to meet the deadline date to file the form and comply with the necessary eligibility factors related to the childs eligibility, benefits will be terminated with an advance notice.
(C) If the CAO has not been notified of the newborn childs birth by the end of the grace period, benefits for the child will be authorized effective with the date that the child is determined to be eligible, but no later than 15-calendar days after a common application form has been filed and a partial redetermination completed.
(D) Underpayments caused by administrative errors concerning newborn childrens eligibility will be corrected in accordance with § 227.24(d)(1)(ii)(A)(IV) (relating to procedures).
(c) Redetermination contacts. Redetermination contacts with the client may be in the home or in the office, depending on the preference of the client. Office and home visits shall be scheduled with the client. It may not always be possible to plan a visit so that home visits to the client without notice may be occasionally necessary; for example, when substantiating information is required and urgent to determine the continued eligibility of the client. Home visits shall always be made in accord with the principle of the Department respecting the right of the client to privacy and personal dignity as set forth in § 121.1 (relating to policy).
(d) Controls for redeterminations. To carry out the function of redetermining eligibility, a central control of necessary future actions is maintained to provide a method whereby reasonably predictable changes in the total caseload can be acted on within appropriate time limits.
The provisions of this § 133.23 amended under sections 201(2), 401(a), 403(b), 405, 405.1, 405.3, 432 and 432.21(a) of the Public Welfare Code (62 P. S. § § 201(2), 401(a), 405, 405.1, 405.3, 432 and 432.21(a)); 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; the Domestic Relations Code, 23 Pa.C.S. § § 43014381, 5103, 71017901 and 81018418; and the act of May 16, 1996 (P. L. 175, No. 35).
The provisions of this § 133.23 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; amended October 27, 1978, effective November 27, 1978, 8 Pa.B. 2909; amended February 22, 1980, effective March 1, 1980, 10 Pa.B. 850; amended November 6, 1981, effective November 7, 1981, 11 Pa.B. 3959; explained November 6, 1981, 11 Pa.B. 3954; corrected July 9, 1982, effective June 26, 1982, 12 Pa.B. 2171; amended June 25, 1982, effective June 26, 1982, 12 Pa.B. 1938; amended April 8, 1983, effective April 9, 1983, 13 Pa.B. 1259; amended August 26, 1988, effective November 1, 1988, 18 Pa.B. 3893; amended August 26, 1988, effective November 1, 1988, 18 Pa.B. 3921; amended October 4, 1991, effective October 5, 1991, apply retroactively to November 1, 1989, 21 Pa.B. 4643; amended February 7, 1992, effective upon publication and apply retroactively to February 1, 1990, 22 Pa.B. 590; amended July 28, 2000, effective retroactive to July 1, 1995, 30 Pa.B. 3779; amended September 13, 2002, effective retroactively to March 3, 1997, with the exception of subsection (a)(1)(i)(A) which becomes effective September 14, 2002, 32 Pa.B. 4435; amended October 11, 2002, effective October 12, 2002, 32 Pa.B. 5048. Immediately preceding text appears at serial pages (290892) to (290897).
Notes of Decisions
Burden of Proof
Since the duty to demonstrate eligibility is on the claimant, the denial of assistance is proper if the claimant fails 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).
Issues Before the Court
Since a client could sign the form requiring ethnic and citizenship data without perjuring himself under 62 P. S. § 481, there was no question of validity or constitutionality before the court. El v. Department of Public Welfare, 406 A.2d 1198 (Pa. Cmwlth. 1979).
Since the caseworker was aware of the recipients eligibility for the allowance for medical transportation expenses, the caseworker was required under 55 Pa. Code § 133.23(a)(2)(ii)(E) (relating to requirements) 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).
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 sufficient substantial evidence to reverse the Secretarys reversal of the Hearing Examiners opinion reinstating recipients benefits. Augelli v. Department of Public Welfare, 468 A.2d 524 (Pa. Cmwlth. 1983).mation was available in the county office newsletter. Scott v. Department of Public Welfare, 400 A.2d 1350 (Pa. Cmwlth. 1979).
This section cited in 55 Pa. Code § 133.73 (relating to requirements); 55 Pa. Code § 140.103 (relating to verification of income); 55 Pa. Code § 141.21 (relating to policy); 55 Pa. Code § 147.24 (relating to procedure); 55 Pa. Code § 175.22 (relating to definitions); 55 Pa. Code § 175.23 (relating to requirements); 55 Pa. Code § 183.5 (relating to income verification); 55 Pa. Code § 187.23 (relating to requirements); 55 Pa. Code § 201.3 (relating to requirements); 55 Pa. Code § 225.24 (relating to procedures); and 55 Pa. Code § 227.24 (relating to procedures).
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