When the SAR form is not returned or is returned late or incomplete, the Late/Incomplete Notice (L/IN, PA 564-A) is sent. (See Chapter 571, Appendix A.) The L/IN serves as the Advance Notice to close for the cash and SNAP programs. The L/IN includes:
Questions from the SAR that were not answered, along with the pre-populated information as it appeared on the SAR form.
The extended due date when the L/IN must be in the CAO.
NOTE: The L/IN does not serve as an Advance Notice for the Medical Assistance program. To close or change a Medical Assistance program through the SAR process, the CAO must send an Advance Notice. See Medical Assistance Handbook, Section 377.4.
Question #1 will always be printed and answered on the L/IN for use as a reference for the recipient to answer other questions. If this question was not answered or completed by the recipient, the question “Did anyone move into or out of your household?” will also appear on the L/IN.
The completion of the tracking screen based on the information provided on the SAR form will directly impact the information on the L/IN. For example:
If all questions are incomplete, and the ALL boxes on the SAR form and on the CCMRTK screen are checked, then all questions and data from the SAR form will be printed on the L/IN.
If the SAR form is not signed, and the UNSIGNED boxes on the SAR form and on the CCMRTK screen are checked, then the L/IN will tell the client, “You did not sign your semiannual reporting form. Please sign the certification section and return the form.”
1. Did anyone move into or out of your household? If yes, list who and their relationship to you.
Question #1 asks for a report of changes in who lives in the household. Block 1 is checked if question #1 is not answered or is incomplete. There is no longer a requirement to track verification for this question. The caseworker should contact the recipient as needed.
2. Did any household member start a new job, change a job, or stop working? If yes, list any changes, such as job start date, end date, date of first pay, how often paid). Provide proof (pay stubs, employer statements, etc.).
Question #2 asks for a report of employment changes. Block 2 is checked if question #2 is not answered and both the question and the data are printed on the L/IN. If the household reports changes, verification must be provided. Block 2V is checked if proof of changes is inadequate or not attached, and the statement “You did not provide proof of any changes” is printed. If both Block 2 and 2V are checked, the question and the data will be printed on the L/IN.
3. Provide proof (pay stubs, employer statements, etc.) of all work income any household member received in the month of [reporting month]
Question #3 asks for a report of earned income. If a household member has earned income in the reporting month, proof must be provided. If all proof is not provided or is inadequate, Block 3V is checked, and the following statement is printed on the L/IN: “You did not provide proof of any changes."
4. Did any household member lose or start receiving income or have a change in amount? If yes, list any changes. Provide proof (award letter, support court orders, etc.).
Question #4 asks for a report of unearned income changes. Block 4 is checked if question #4 is not answered and both the question and the data are printed on the L/IN. If the recipient reports changes, verification must be provided. Block 4V is checked if proof of changes is inadequate or not attached, and the statement "You did not provide proof of any changes" is printed. If both Block 4 and 4V are checked, the question and the data will be printed on the L/IN.
5. Is the address on this form your current address? If no, what is your new address? Provide proof (Examples: lease, landlord statement, deed, etc.).
If you receive SNAP benefits and you have moved, what are your shelter (rent/mortgage) and utility costs? Do you pay for your own heating and/or air conditioning?
Question #5 asks for a report of an address change. Block 5 is checked if the question is not answered, and Question #5 is printed on the L/IN. Data is not filled in for this question, but the recipient has space to provide a new address. The portion of the question regarding shelter and utility costs does not need to be answered or verified and will not be tracked. Recipients are advised in the Instructions section that if this information is not provided, it may result in less or no SNAP benefits.
6. Did any household member have a change in the amount he is requested to pay? If yes, list any changes. Provide copy of support court order or letter and proof of payment.
Question #6 asks for a report of the amount of support paid for children outside the household. This question is not required to be tracked and has no corresponding block on the SAR form. Recipients are advised in the instructions that changes in support paid will affect SNAP benefits and that they may receive less or no SNAP benefits if this information is not provided and verified. This question will appear on the L/IN only if the SAR form is not received or if the ALL box is checked on the SAR form.
7. Are there any changes? If yes, list any changes. Provide copy of bill or statement from caregiver.
Question #7 asks for a report of the amount paid for child care or for care of a sick or disabled person. Recipients are advised in the instructions that changes in support paid will affect SNAP benefits and that they may receive less or no SNAP benefits if this information is not provided and verified. This question will appear on the L/IN only if the SAR form is not received or if the ALL box is checked on the SAR form.
8. Has the information in this section changed? Does any household member have resources not listed above? If you answered yes to either question, list any changes. Provide proof (copy of bank statement, vehicle registration, etc.)
Question #8 asks for a report of household resources. Block 8 is checked if the recipient does not answer either or both questions.
Exception: The CAO must not mark this question as incomplete, regardless of the answers, if resource information is not required in the eligibility determination according to Medical Assistance Handbook, Section 340.1.
Question #8 and the data information are printed on the L/IN. If required changes are reported, proof of resource changes must be provided. Block 8V is checked if the proof of changes is inadequate or not attached, and the statement "You did not provide proof of any changes" is printed. If both Block 8 and 8V are checked, the question and the data will be printed on the L/IN.
Reminder: The CAO worker must always narrate any incomplete verification. This will make it easier for CAO and Change Center staff to help recipients with any questions on what information must be provided.
Reissued March 1, 2012, replacing September 30, 2008