Overpayments - General Referral Information

State law (Welfare and Institutions Code Section 18940) requires, with limited exceptions, that the Federal and State laws governing the SSI/SSP program must also govern CAPI. Accordingly, the federal laws governing SSI/SSP overpayments must also govern CAPI overpayments.

The first step in determining if an overpayment occurred and the amount of the overpayment, is to compare the amounts due to the amounts paid for the month(s) in question. The comparison will normally be made during the redetermination (RRR) process, but it may be done at any time a change is reported or a case is reviewed. All case files must contain documentation of the overpayment amount(s), the month(s) reviewed, the reason for the overpayment(s) and action taken.

The EW must document the reason for the overpayment in a CalSAWS Journal Entry, and the months in question. Once this information is documented, the EW must ensure that appropriate steps are taken to ensure that the CAPI overpayment is processed.

Promptness Requirement

The EW must take all reasonable steps necessary to promptly correct and collect any overpayments that are known. This includes recovering overpayments due to either client or administrative error.
Once the amount of the overpayment is calculated, the EW must take the following actions.

Send the client an adequate Notice of Action (NA 1217), which shows the overpayment computation and explains the reason the overpayment occurred. The notice must contain information regarding the client’s right to request a waiver. Allow client 30 days to return the NOA and request waiver and/or payment method.
Begin monthly recoupment the 1st of the following month in which the 30 day period ends.

Case Record Overpayment Claim Information

A claim is recorded in CalSAWS, and information about the overpayment, the balance owing and the liable individuals are retained in the CalSAWS case record. This will allow recoupment to begin again, should the individuals from the overpaid CAPI case reapply and be determined eligible for CAPI.

Non-System Determined Claim (NSDC)

Claims can be manually recorded in CalSAWS for the following circumstances: (The liable individual and the CalWORKs program must be known in CalSAWS).

An overpayment determined for months preceding system conversion.
A claim on an Inter-County Transfer.
When there are multiple claims with different error types within the same month.

Suspected Fraud

When information in the case record, or other information received, indicates that there is a possibility that an overpayment may have occurred or is occurring, it is the responsibility of the EW to review the case and determine if eligibility was or is affected and proceed accordingly.

There are many indicators which the EW may observe or receive that cause the EW to suspect that there is an overpayment. These include, but are not limited to:

Conflicting information provided by the client or in the case record
Community complaints
Needs in excess of the amount of assistance received
Client’s passport indicates an unreported absence out of the country.

EW/Client Responsibility

It is the responsibility of the client to provide any required information to assist the EW in correctly determining eligibility for the CAPI individual. The EW must assist the client in obtaining any required information which is not in the possession of the client. This includes sending for items which verify the client’s statements. The client must complete and sign the “Release of Information” (CSF 13) specifically noting the information required.

Use of CSF 2

If a client is unable to provide documentation or verification of his/her statement, a “General Affidavit” (CSF 2) may be taken.
When having the CSF 2 completed by the client, the EW must:

Ensure that the client understands that the form is being completed under penalty of perjury.
Have the client provide the requested information in their own writing and using their own words to describe the facts.
Witness the client’s completion of the form and the signature.
Sign the bottom of the form as the witness to the client’s statement and signature.
Document all actions taken in a Journal Entry.
Ensure that the signed CSF 2 is scanned to Imaging.

If the CSF 2 is not completed in the presence of the EW, but is being filled out by another individual who is making a statement in support of the client’s facts, the EW MUST request that the form be notarized.

Reminder: If this step is not completed, then the affidavit is NOT ACCEPTABLE because it is not valid or enforceable.

Action Based on CSF 2

Based upon the recipient’s statement on the CSF 2, the EW must take appropriate action based on the following information.

If the statement seems reasonable and there is no conflicting information, then No further action is needed.
If the statement still does not clarify all the questions or does not seem reasonable, then:
- Make a General Fraud Referral
- Document in a Journal Entry that a General Fraud Referral was initiated and the actions taken and why.

Note: If in doubt about the potential fraud, contact the DA’s office. The EW must weigh all available information and then take appropriate action.

Fraud Referral to District Attorney (DA)

When fraud is suspected, a referral must be sent to the DA’s Office. This is used only when the EW suspects that fraud is occurring, or has occurred, in a particular case. [Refer to “General Fraud Referral,” page 42.11] of the Common Place Handbook for additional information.

If there is doubt about the appropriateness of the referral, the EW may discuss the case with their supervisor.

If there has been a community complaint, that information can also be documented in the referral. Any other documentation in the case record which substantiates the EW’s suspicions should also be included, as well as any information which supports the client’s contentions.