D. INITATING A FRTS REFERRAL

 

Referral Initiated

If the Human Services Specialist (HSS) is unable to resolve the discrepancy, inconsistency or a fraud allegation after necessary steps have been taken, and there is no previous referral still in pending status, a fraud referral will then be initiated.  The HSS should make the referral immediately upon determination that a referral is needed. 

 

The earlier a referral is made, the better the chance that the HSS will have the result of the investigation before granting new/additional aid, and/or to discontinue/reduce the benefits to which the applicant/recipient is not entitled at the earliest time possible.  Fraud referrals are to be made using the Fraud Referral Tracking System (FRTS). 

 

 

FRTS Narrative

The FRTS Narrative Section must contain:

 

·       A clear, specific explanation of the suspicion/allegation.  For example, name and address of the employer or source of other income, if known, on an Unreported Income Allegation;

·       The period of time covered by the allegation.  This is especially important for allegations on closed cases since what happened to the applicant/recipient after the case closed is no longer a concern to the case; and,

·       What steps the HSS has taken trying to resolve the issue before the referral was made.

 

NOTE: Information regarding the availability and quality of evidence is a major consideration in the acceptance and assignment of referrals by PAF. Therefore, the following shall also be included in the referral, if available:

 

·       The whereabouts of the person suspected of committing fraud;

·       The length of time and dollar amount involved; and

·       Prior willful overpayments, fraud convictions or suspected fraudulent history,

 

 

Fraud Referral
Attachments

Attachments necessary for the investigation must be forwarded to PAF immediately, upon completion of the referral on FRTS.  Attachments must be given to the EFD/P investigator in the Family Resource Center (FCR) on EFD/P referrals or sent to PAF mail stop W413 on Full Field referrals, as appropriate. 

 

A completed 16‑55, "FRTS Attachments" coversheet must be sent along with any relevant attachments in order to identify the referral.  Any additional information received after the referral has been made will be given to the in-house FRC EFD/P investigator (on EFD/P referrals) or sent to PAF (on Full Field referrals) by using the "Additional Comments" section in FRTS. 

 

Fraud Referrals and  Attachments:

 

Fraud Referral Regarding

Documentation (attachments)

Residency Questionable

Indicate:

 

·       Why residency violation is suspected and what actions have been taken to resolve it

·       Source of information

·       Prior residence information (even if in Mexico)

·       All children's names, DOB's and SSN's

 

Attach:

 

·    Applicant/recipient's ID (copy of driver license, alien card, etc.)

·      Rent receipt, rental agreement (with landlord's name, address and telephone number)

·      Utility receipt

·      Housing Questionnaire

·      Affidavit of living situation

·      Vehicle registration

 

Absent parent in home

Indicate:

 

·       What caused the allegation / what actions have been taken to resolve the issue

·       Source of information

·       Name, DOB and SSN of the A/P

·       Year, make, model and license number of the vehicle driven by the A/P

·       Name, address, and phone number of the A/P's current or last known employer

 

 

Attach:

 

·       Copy of A/P’s ID

·       Copy of the most recent CW 371, CW 2.1 and CW 2.1(Q)

·       Vehicle registration under the A/P's name

·       Bank account statement under the A/P's name

·       Rental verification/utility bills in A/P’s name

·       Document indicating other name(s) ever used by the A/P

 

 

Unreported Income

Indicate:

 

·       Why applicant/recipient is suspected of having unreported income and what actions have been taken

·       Source of the alleged income

·       Name and place of employment

·       Name and SSN under which the applicant/recipient is employed

·       Hours and days of employment

·       Name of child’s care provider

·       Name of person having contact over employment (supervisor, boss, owner, manager, etc.).

·       Method used for commuting to and from work

 

Attach:

 

·       Copy of applicant/recipient's ID.

·       Copy of the “Display Employment History” screen showing start and end date of employment.

·       If unreported child support, copy of CW 2.1Q.

·       Bank statements showing unexplained deposits

·       Copies of pay stubs or employment verification

 

Unreported Property

Indicate:

 

·       Why the applicant/recipient is suspected and what actions have been taken to resolve the issue

·       Source of the allegation

·       Type of property involved (vehicle, house, land, bank account, etc.) and property identifier (vehicle license #, bank account number, etc.

 

Attach:

 

·       Copy of applicant/recipient's ID

·       Copies of documents showing ownership of the property

 

Needs Exceeding Income

Indicate:

 

·        Reason of suspicion/actions taken to resolve the issue

·        How long the situation has been going on

 

Attach:

 

·       Copy of applicant/recipient’s ID

·       Copy of rental agreement

·       Copy of utility receipt

·       Affidavit of living situation

·       Sworn statement (applicant/recipient's explanation as to how needs are being met)

 

 

Granting Actions Required Pending Investigation

In some instances, it may be necessary to grant aid prior to the completion of the investigation in order to meet immediate need, Homeless Assistance time frames, or other program requirements.  Under these circumstances, the HSS will grant apparent eligibility/temporary shelter costs until the case can be certified eligible. Food Stamp Expedited Services may not be delayed pending the completion of an investigation. 

Should a question arise whether to grant or delay, the HSS is to discuss the case situation with his/her supervisor, and document the decision in the case narrative.

 

 

Solicitation Referrals

Soliciting, as related to fraud, is the act of tempting or enticing someone to do wrong.  This includes advising or coaching applicants how to answer questions, conceal information, or provide false or fraudulent information to:

·       Establish eligibility to benefits, or

·       Obtain greater benefits than would otherwise be available, or

·       Prepare for an investigation of their circumstances.

 

 

Referral Pended

In situations when additional information needed for a full field referral is minimal, PAF will pend the referral and note what verifications and/or information is needed in the “Comments” section on the WASS screen.  Comments entered on the WASS screen will print on the Welfare Referral Investigations Pending Acceptance Report generated in the batch process to the HSS.

 

 

Timelines for Pending Referrals

·  The HSS has 10 days to respond to PAF from the date the Welfare Investigations Pending Acceptance Report is received.

 

If…

Then…

No response is received by PAF

A second report is generated to the HSS and SHSS with 5 days to respond to PAF from the date the second report is received.

If no response to the 2nd report is received from the HSS and/or SHSS

Then a roll-up report is sent to the FRC Manager allowing 5 additional days from the date the roll-up report is received to respond to PAF.

The 5 additional days have passed and no response is received

PAF will contact the Regional General Manager for a response.

 

 

 

Fraud Referral Rejections

The rejection of a referral by PAF will not be the end of the process if the need for an investigation still exists.  The response from PAF will indicate the reason for rejecting the referral.  The HSS has the responsibility to promptly follow-up on the rejection, as appropriate, and immediately initiate a new referral to PAF using a new tracking number.

 

Reason For Rejection

Prevention Measures

Duplicate referral

 

The HSS transmits new or additional allegation, information to PAF by creating a new referral while a referral has previously been made and accepted by PAF

Prior to transmitting a referral to PAF, the worker needs to check the case record to determine whether there is a referral pending on the same case.  If there is a pending referral, the new/additional information should be communicated to PAF by entering the information in FRTS.

Referral Should Be Made To Early Fraud, Not Full Field, if:

 

·       SAWS 1 date is less than 90 days old

·        Information is derived directly through renewal process

·        Referral is regarding the application for new or additional funds

·       Referral is on an incoming Inter-county transfer (ICT

Compare the case status to the EFD/P referral criteria to determine whether the referral should be an EFD/P or Full Field referral.

Improper referrals

 

 Referrals were made on allegations of drug use, child abuse or UAM (who is not the father of a child in the assistance unit) in home, or to request a DMV clearance.

·      Only allegations that appear to have a direct impact on the applicant/recipient's eligibility for public assistance or benefit level will be referred to PAF.

·      Other allegations shall be referred to the appropriate authority.

 

1.      For example, a child abuse allegation should be referred to Child Protective Services, not PAF

2.      Also, a DMV clearance request on an over 90 days granted case should be made to the FRC EFD/P investigator via a gram, not by a referral to PAF.

3.      When paternity is at issue, a referral shall be made to the Local Child Support Agency and not to PAF