Filetype Excel XLSX | Posted on 05 Jul 2022 | 4 years ago
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366x Filetype XLSX File size 0.04 MB Source: economicbenefits.nc.gov
Sheet 1: FNS Apps-Late Recerts
| Income Maintenance | ||||||
| Food & Nutrition Services (FNS) Second Party Review Checklist Tool | ||||||
| Date Reviewed: | Case Manager: | |||||
| Case Name: | Case Manager's Supervisor: | |||||
| PDC/ISA: | Quality Sample Review Completed by: | |||||
| Application/Late Recertification Date: | Quality Sample Results: | |||||
| Type of Action Completed: | Corrections Due By: | |||||
| Date Action Completed: | ||||||
| Applications/Late Recertifications: | Correct | Comments by Reviewer | Worker Response | |||
| Yes | No | N/A | ||||
| Complete/signed application filed that included the applican'ts name, address and signature? | ||||||
| Application submitted in NC FAST within 3 days? | ||||||
| Method of recertification updated in NC FAST prior to submitting the late recertification? | ||||||
| DSS-1688, Designation of Authorized Representative form completed, if applicable? | ||||||
| Authorized Representative evidence entered in NC FAST accurately? | ||||||
| Interview required? | ||||||
| Interview documented on the Interview Tab for applications? | ||||||
| If interview not conducted on DOA, was the client scheduled appointment on the DSS-8650, Notice of Information Needed to Complete Your FNS form with specific time, date and method of interview? | ||||||
| If interview required and unable to reach household by phone, was the DSS-8650, Notice of Information Needed to Complete Your FNS form for interview sent no later than day following DOA scheduling the interview within 3 calendar days? | ||||||
| Application/late recertification screened for Expedited Services? | ||||||
| If eligible for Expedited Services, was it processed subject to Expedited Services? If not, why and was the decision correct? | ||||||
| Identity of applicant and/or authorized rep verified for Expedited Services? | ||||||
| Expedited Services processed allowing the household to access benefits by the 7th day? | ||||||
| If subject to Normal Processing, was the case processed allowing the household to access benefits by the 30th day? | ||||||
| Was Regulatory Delay used? If yes, was the use appropriate based on policy? | ||||||
| Eligibility for the Application or Recertification: | Correct | Comments by Reviewer | Worker Response | |||
| Yes | No | N/A | ||||
| Household was evaluated for categorical eligibility correctly? | ||||||
| Citizenship for all household members correct? | ||||||
| SAVE completed on all non-citizen household members when applicable? | ||||||
| Enumeration provided for all household members? | ||||||
| Residency verified if not Cat-El? | ||||||
| Resources verified if not Cat-El? | ||||||
| Controlled Substance Felons or Fleeing Felons assessed and appropriately disqualified? | ||||||
| H or I Drug Felon disqualification cured if applicable? | ||||||
| Does the documentation support the household members that are included or ineligible household members? | ||||||
| Ineligible household members excluded correctly? | ||||||
| OVS requested for all household members and reconciled? | ||||||
| DSS-8568, ABAWD Requirements form verbally explained (for interviews only)? | ||||||
| DSS-8568, ABAWD Requirements form provided? | ||||||
| ABAWD months been recoded if appropriate? | ||||||
| DSS-8640, Work Requiements Responsibilities form completed for all work registrants? | ||||||
| Work registration/non-participation coding in NC FAST accurate? | ||||||
| Base period unearned income verified and calculated correctly? | ||||||
| Base period earned income verified and calculated correctly? | ||||||
| If base periods were moved, was the case documented to support the action? | ||||||
| Income entered in NC FAST accurately? | ||||||
| Shelter expenses verified and entered in NC FAST accurately? | ||||||
| Utility deduction entered in NC FAST accurately? | ||||||
| Daycare expenses documented, verified and entered in NC FAST accurately? | ||||||
| Medical expenses documented, verified and calculated correctly for Specified Persons? Entered in NC FAST accurately? | ||||||
| Legal Support Obligation for a child not in the home? If yes, was the deduction entered in NC FAST accurately? | ||||||
| DSS-8650-A, Notice of Information Needed form provided to the FNS household as required? | ||||||
| DSS-8650, Notice of Information Needed to Complete Your FNS request for required and mandatory verifications only? No unnecessary requests? | ||||||
| Verifications received date stamped appropriately? | ||||||
| Data Matches/Tasks managed and closed appropriately? | ||||||
| DSS-8194, Income Maintenance Transmittal tasked to active programs? | ||||||
| Voter Registration offered and documented? | ||||||
| Denials/Approvals: | Correct | Comments by Reviewer | Worker Response | |||
| Yes | No | N/A | ||||
| If denied, was denial correct? | ||||||
| For approvals, was the assigned certification period correct? | ||||||
| DSS-8551 - Notice of Eligibility, Denial or Pending Status correct? | ||||||
| Notice sent to the last reported address? | ||||||
| Notice in the preferred language of the applicant/recepient? | ||||||
| DSS-8550 - Change Report Form provided for approvals? | ||||||
| EBT card issued if needed? | ||||||
| Case narrative clear and complete to support all actions? | ||||||
| Notice sent to the last reported address? | ||||||
| Totals | Yes | No | ||||
| 0 | 0 | |||||
| Percentage Correct | 0% | |||||
| Income Maintenance | ||||||
| Food & Nutrition Services (FNS) Second Party Review Checklist Tool | ||||||
| Date Reviewed: | Case Manager: | |||||
| Case Name: | Case Manager's Supervisor: | |||||
| PDC/ISA: | Quality Sample Review Completed by: | |||||
| Application/Recertification Date: | Quality Sample Results: | |||||
| Type of Action Completed: | Corrections Due By: | |||||
| Date Action Completed: | ||||||
| Timely-Untimely Recertifications: | Correct | Comments by Reviewer | Worker Response | |||
| Yes | No | N/A | ||||
| Was a complete/signed recertification filed? | ||||||
| Was the recertification submitted in NC FAST within 3 days? | ||||||
| Method of recertification updated in NC FAST prior to submitting the recertification. | ||||||
| Was an interview required? | ||||||
| Was the interview documented on the Events tab for timely/untimely recertifications? Or Interview Tab for Late Recertifications? | ||||||
| Was the recertification approved or denied correctly? | ||||||
| Was the notice in the preferred language of the applicant/recepient? | ||||||
| Was the notice correct? | ||||||
| Was the notice sent to the last known address of the household? | ||||||
| Was the recertification closed and reopened? | ||||||
| Was the recertification reopened correctly? | ||||||
| If the recertification was reopened in the 2nd 30 days, was the case approved within 5 days of receiving the last verification? | ||||||
| Eligibility for the Timely-Untimley Recertification: | Correct | Comments by Reviewer | Worker Response | |||
| Yes | No | N/A | ||||
| Household was evaluated for categorical eligibility correctly? | ||||||
| Is citizenship for all household members correct? | ||||||
| Was SAVE completed on all non-citizen household members when applicable? | ||||||
| All household members have provided verification of enumeration? | ||||||
| Residency verified if not Cat-El? | ||||||
| Resources verified if not Cat-El? | ||||||
| Were any Controlled Substance Felony or Fleeing Felons assessed and appropriately disqualified? | ||||||
| If applicable, H or I Drug Felon disqualification cured? | ||||||
| Does the documentation support the household members that are included or ineligible household members? | ||||||
| For any ineligible household members, have they been excluded correctly? | ||||||
| Was OVS requested for all household members and reconciled? | ||||||
| Was DSS-8568, ABAWD Requirements form verbally explained (for interviews only)? | ||||||
| Was the DSS-8568, ABAWD Requirements form provided? | ||||||
| Have ABAWD months been recoded if appropriate? | ||||||
| Was a DSS-8640, Work Requiements Responsibilities form completed for all work registrants? | ||||||
| Is the work registration/non-participation coding in NC FAST accurate? | ||||||
| Was the base period unearned income verified and calculated correctly? | ||||||
| Was the base period earned income verified and calculated correctly? | ||||||
| If base periods were moved, was the case documented to support the action? | ||||||
| Was the income entered in NC FAST accurately? | ||||||
| Were shelter expenses verified and entered in NC FAST accurately? | ||||||
| Correct utility deduction entered in NC FAST? | ||||||
| Child Care expenses documented, verified and entered in NC FAST accurately? | ||||||
| Medical expenses documented, verified and calculated correctly for Specified Persons? Entered in NC FAST accurately? | ||||||
| Legal Support Obligation for a child not in the home? If yes, was the deduction entered in NC FAST accurately? | ||||||
| DSS-8650-A, Notice of Information Needed form provided to the FNS household as required? | ||||||
| DSS-8650, Notice of Information Needed to Complete Your FNS request for required and mandatory verifications? No unnecessary requests? | ||||||
| Verifications received date stamped appropriately? | ||||||
| Data Matches/Tasks managed and closed appropriately? | ||||||
| DSS-8194, Income Maintenance Transmittal tasked to active programs? | ||||||
| Voter Registration offered and documented? | ||||||
| Denials/Approvals: | Correct | Comments by Reviewer | Worker Response | |||
| Yes | No | N/A | ||||
| If denied, was the denial correct? | ||||||
| For approvals, was the assigned certification period correct? | ||||||
| DSS-8551 - Notice of Eligibility, Denial or Pending Status correct? | ||||||
| Was the notice sent to the last reported address? | ||||||
| Was the notice in the preferred language of the applicant/recepient? | ||||||
| DSS-8550 - Change Report Form provided for approvals? | ||||||
| EBT card issued if needed? | ||||||
| Case narrative clear and complete to support all actions? | ||||||
| Notice sent to the last reported address? | ||||||
| Totals | Yes | No | ||||
| 0 | 0 | |||||
| Percentage Correct | 0% | |||||
| Income Maintenance | ||||||
| Food & Nutrition Services (FNS) Second Party Review Checklist Tool | ||||||
| Date Reviewed: | Case Manager: | |||||
| Case Name: | Case Manager's Supervisor: | |||||
| PDC/ISA: | Quality Sample Review Completed by: | |||||
| Date Termination Completed: | Quality Sample Results: | |||||
| Corrections Due By: | ||||||
| Ongoing Terminations: | Correct | Comments by Reviewer | Worker Response | |||
| Yes | No | N/A | ||||
| Change required to be acted upon based on the FNS unit's reporting requirements, reported to FNS from within agency or became known as new/changed information recorded in NC FAST generating a task? | ||||||
| Change reacted to appropriately within 10 calendar days of receipt of the change? | ||||||
| Change entered in NC FAST using current system instructions regarding start/end state for new/changed evidences? | ||||||
| Was the reason for termination documented? | ||||||
| Was there supporting verification to support the decision to terminate? | ||||||
| DSS-8553, Notice of Adverse Action sent within 10 calendar days of the reported change? | ||||||
| Notice in the preferred language of the applicant/recepient? | ||||||
| Notice sent to the last reported address? | ||||||
| Benefits terminated effective the month following the month in which the DSS-8553 expired? | ||||||
| Case narrative clear and complete to support all actions? | ||||||
| Totals | Yes | No | ||||
| 0 | 0 | |||||
| Percentage Correct | 0% | |||||
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