63-273 Quarterly Eligibility/Status Report Form (QR 7)

Table of Content

	Section
Worker Responsibility in Providing Assistance with the QR 7	273.1
QR 7 Review	273.2
Completeness Criteria for the QR 7	273.3
Verifications Required with the QR 7	273.4

63-273.1

Worker Responsibility in Providing and Assisting With the QR 7

The worker, at the time of the application interview, will determine which households are subject to QR requirements and will:

· Provide all QR households with the QR 7 for reporting the information and changes required by Section 63-273.3 below.

· Provide assistance in completing and filing the QR 7 to households whose adult members are all either mentally or physically disabled, non-English speaking or lacking in reading and writing skills and unable to complete and submit the QR 7.

· Require QR households to submit a complete QR 7 by the 5th of each Submit Month.

The worker will ensure that:

· Households are mailed the QR 7 at the end of each QR Data Month and no later than the first day of each QR Submit Month. Information reported on the QR 7 will be used to determine eligibility and to prospectively budget income to determine the benefit level for the upcoming QR Payment Quarter.

· QR recipients provide information and answers to all questions and items on the QR 7 and attest, under penalty of perjury, that they have truthfully reported all required information.

Recipients will be required to report all income received for the QR Data Month, any changes in household composition or property since the last Data Month, and any changes in income the recipient anticipates will occur in the upcoming QR payment quarter.

Note: Recipients have the option of submitting the QR 7 in person, by mail, by fax, or electronically via Benefits CalWIN.

63-273.2

QR 7 Review

Upon receiving the QR 7 the worker will:

Step	Action
1	Review the report to ensure completeness and consider the report incomplete if not meeting the criteria for a complete QR 7, as defined in Section 63-273.3 below.
2	Determine those items which will require additional verification and/or clarification.
3	Notify the household of the need to correct an incomplete or inaccurate QR 7, and/or submit additional verification or clarification (Section 63-274.3).
4	Determine the household’s eligibility prospectively by considering all factors, including income.
5	Determine the household’s level of benefits for that next QR Payment Quarter based on information reported on the QR 7 (including anticipated income for that QR Payment Quarter), and household composition determined as of the Data Month. In calculating the household's benefit level, the following income and deductions will be considered: a. Non-excluded earned and unearned income received in the corresponding Data Month and any anticipated changes for the next QR Payment Quarter. The worker will use the actual/reasonably anticipated amount received by the household to compute benefits. b. Allowable deductions as billed or averaged from the corresponding payment quarter or as averaged over the certification period, including those shelter costs billed less often than monthly which the household has chosen to average. Refer to Section 63-275.1, Action on Changes Reported on the QR 7.
6	Issue benefits, in accordance with the time frames set forth in Section 63- 274.3, Notice of Action.

63-273.3

Completeness Criteria for the QR 7

The worker will consider the QR 7 complete if all of the following requirements are met.

· The QR 7 is dated no earlier than the first day of the Submit Month.

o This requirement will be met when the date entered on the QR 7, together with other dated material provided with the QR 7, and the date on which the worker mailed or gave the QR 7 to the household clearly established the month and year to which the QR 7 applies.

o This requirement will not apply when:

§ The first day of the Submit Month falls on a non-postal delivery day;

§ The QR 7 is mailed by the worker for delivery on the last postal delivery day of the Data Month; and

§ The recipient signs and dates the QR 7 on or before the last day of the Data Month.

· The QR 7 provides the worker with address (location) information sufficient to locate the household. However, households without a fixed address will not have their QR 7s rendered incomplete solely for this reason.

· The QR 7 is signed by the head of household, authorized representative, or responsible household member. (The PA caretaker relative, natural or adoptive parent, if not one of the above, will not satisfy this requirement).

· All questions and items pertaining to CalFresh eligibility are fully answered and provide the worker with the information to correctly determine eligibility and benefit level.

To be considered fully answered, information on the QR 7 together with attached documentation must provide sufficient information to allow for the determination of eligibility and/or benefit level.

Questions on the QR 7 will not be considered fully answered if situations such as, but not limited to the following exist:

o The QR 7 does not include information on changes that the household has previously reported to have occurred; for example, an actual change that the household reported to the worker by telephone mid-quarter was not included on the QR 7. However, the QR 7 would not be considered incomplete if the recipient fails to report on the QR 7 a shelter cost increase that was voluntarily reported mid-quarter. ACIN I-10-04

o The QR 7 does not include information that was reported on the previous QR 7 and the household does not indicate a change has occurred (e.g., the household previously reported earnings from two sources and only reported income from one source on the current QR 7).

o If elements pertaining to one program's requirements are missing from the QR 7, the QR 7 will be considered incomplete for that program only.

o The worker will not consider the QR 7 incomplete if information regarding child/spousal support disregard payments has not been included.

· Verification is provided for gross non-excluded earned income and non-excluded unearned income for the Data Month when first reported and when there is a change in the amount of income received.

· For child/spousal disregard payments, the agency record will be the verification.

· Verification is provided for the source of all excluded income when first reported on the QR 7 and any change in the source of the income.

63-273.4

Verifications Required With the QR 7

The household will provide with the QR 7 verification of the following items:

· Dependent care costs which have changed since the last report or when there is questionable information which is inaccurate, incomplete, outdated, or inconsistent.

· If the household voluntarily reports a change in medical expenses and fails to verify the change, and that change would increase the household’s allotment, the worker will not make the change.

The worker will act on reported medical expense changes without requiring verification if the changes would decrease the households’ allotment or make the household ineligible. However, a required verification will be obtained before the household is recertified.

· All expenses incurred in producing self-employment income.

· Residency when there is a change except for categorically eligible households.

· Social Security numbers or citizenship or noncitizen status for household members when there is a change.

· A change in the legal obligation to pay child support to a person not in the CalFresh household and/or an increase in the amount of child support payments.

· The worker may elect to require verification of housing costs if the expense is questionable.

The worker is required to offer assistance to the household in completing the QR 7 and in obtaining the verifications (Sections 63-274.2 and 63-117.4).

NOTE: If the household submits information and/or verification with the QR 7 determined to be questionable, the worker will notify the household as specified in Section 63- 274.3. The household will be allowed until the extended filing date to submit the necessary verification and/or clarification.

The worker will contact the household as needed to obtain further information on specific items. These items include, but are not limited to the effect of a reported change in household composition, or loss of job or source of earned income.

Under Modified Categorical Eligibility (MCE), Non-assistance CalFresh (NACF) households are not required to submit verification of resources after receiving the TANF/MOE-funded service “Family Planning – PUB 275” brochure.

The worker will not consider the QR 7 incomplete if a household does not provide verification of resources with the QR 7 and will not evaluate or request verification of resources.

Refer to Section 63-203.19 for additional MCE information.