A. Definitions.

1. (1) Applicant—a person who has, directly, or through his authorized representative, made application for public assistance to the County Department of Social Services and whose application has not been terminated or disposed of by appropriate County Department action.
2. (2) Authorized Representative—someone who is acting for another individual with his knowledge and consent and who has knowledge of the other individual’s circumstances.
3. (3) Application—the action taken by a person or his duly authorized representative by signing a completed application form requesting financial or medical assistance.
4. (4) Effective Date of Application—the date on which the application form is completed and signed by the applicant or his authorized representative.
5. (5) Inquiry—a request for information about eligibility requirements for public assistance.
6. (6) Referral—request for information, service, or aid in behalf of an individual by an agency, institution, or another person.
7. (7) Application Process—all activities from the time an application is accepted until the receipt of payment or other disposition of the application.

B. General Requirements.

1. (1) Accrual Rights.

   1. (a) For all assistance payments programs except those specified below, an applicant’s right to a money payment accrues on the earlier of the following dates, provided he was alive on such date and eligible insofar as is known:

      1. (i) The first day of the month in which the award is authorized by the County Department; or
      2. (ii) The thirtieth day from the date on which a properly signed application form is received.
   2. (b) For the General Disability Assistance (GDA) and General Assistance-Ineligible Spouse (GA-IS) programs an eligible applicant accrues the right to a money payment under the GDA and GA-IS Programs beginning with the first day of the month of certification for payment.

   3. (c) For the Optional Supplementation (OS) program, an eligible applicant accrues the right to an OS payment beginning with the later of the following dates:

      1. (i) The day of application if he has already entered a residential care facility; or
      2. (ii) The day of entry into a residential care facility if he makes application for assistance prior to entry.
   4. (d) A recipient’s right to a money payment accrues on the first day of each month, provided he is alive and eligible on that day.
   5. (e) If a recipient receives an underpayment due to agency error a supplemental payment may be authorized to compensate the recipient for the loss of benefits to which he was entitled. Correction of underpayments shall be limited to the three months prior to discovery of the underpayment. The amount of a supplemental payment shall not be considered as income or as a resource of the recipient in the month paid nor in the next following month. However, any amount remaining after this time period shall be considered as a resource. Underpayments which occur due to client error may be adjusted only through the Fair Hearings procedure in Article 3 of these regulations.
   6. (f) When a recipient of public assistance dies on or after the first day of the month for which an assistance check is issued, such check may be endorsed to the recipient’s spouse or nearest relative by the County Director.
2. (2) Applicants or recipients may request a fair hearing in accordance with Article 3 of these regulations.

3. (3) Overpayments. An overpayment occurs when an assistance payment is made in an amount greater than that to which the recipient is entitled, or when an assistance payment is made to an ineligible recipient. An overpayment may result from any one of the following circumstances.

   1. (a) Agency error, as defined below:

      1. (i) Failure of the agency to take case action immediately when the agency had knowledge of a change in circumstances.

      2. (ii) Failure of the agency to follow up on information when there is an indication in the case record that a change in circumstances could be anticipated and it is later found that such change took place.

         (iii) Failure of the agency to make a redetermination as scheduled.

      3. (iv) Failure of the agency to apply policy or procedures correctly although timely action was taken.
   2. (b) Client error where the client withheld information because of misunderstanding or incapacity of understanding agency program eligibility requirements.
   3. (c) It is the responsibility of the agency to inform the applicant or recipient that he shall furnish to the agency accurate information concerning changes in income, resources or other circumstances which may affect his eligibility to receive assistance within ten days after such change occurs and that the agency may collect from him any assistance received ineligibly.
   4. (d) The recipient of assistance carries the responsibility for the repayment of overpayments received in the form of financial and medical assistance during a period of ineligibility resulting from the failure of the recipient to report changes of circumstances or from giving incorrect information; or pending the outcome of an appeal decision in which appeal the decision of the county department was upheld.
   5. (e) The agency waives collection of overpayments from a recipient when the overpayment was caused wholly or partially by agency error.
   6. (f) The agency waives collection of overpayments resulting from client error, where fraud does not exist, and the overpayment does not result in the recipient’s becoming ineligible for financial assistance.

4. (4) The assistance payments case record shall consist of, but not be limited to, the following documents:

   1. (a) The application and subsequent redetermination forms signed by the individual as a statement of his financial situation;
   2. (b) The agency’s documentation of all eligibility factors;
   3. (c) The forms authorizing or discontinuing payment of the assistance grant or medical assistance benefits and all subsequent status change forms; and
   4. (d) All correspondence, including letters of complaint and appeal requests relating to the individual’s eligibility to receive assistance.