When the SAR form is not returned or is returned late or incomplete, the system sends an L/IN (PA 564 A). The L/IN serves as Advance Notice to close for the Cash Assistance and SNAP programs. The L/IN includes:
Questions from the SAR that were not answered and prepopulated information as it appeared on the SAR form.
The Extended Due Date the L/IN must be in the CAO.
NOTE: The L/IN does not serve as Advance Notice for the Medical Assistance (MA) program. The CAO must initiate an Advance Notice to close or change a MA program based on the SAR process. See Medical Assistance Eligibility Handbook, Section 377.4.
Question #1 will always be printed and prepopulated on the L/IN as a reference for the recipient to answer other questions. If the recipient did not answer or complete Question #1, "Did anyone move into or out of your household?" will also appear on the L/IN.
Completion of the tracking screen based on the information on the SAR form will affect the information on the L/IN. For example:
If all questions are incomplete, check the ALL box on the SAR form and on the CCMRTK screen. All questions and prepopulated data from the SAR form will be printed on the L/IN.
If the SAR form is not signed, check the UNSIGNED box on the SAR and on the CCMRTK screen. 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 any household member move into or out of your household? If yes, list who and their relationship to the household.
Question #1 asks for report of household composition changes.
Block 1 is checked if question #1 is not answered or is incomplete. Verification need not be tracked for this question. The caseworker should contact the recipient if necessary.
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 (Examples: pay stubs, employer statements, etc.).
Question #2 asks for report of employment changes.
Block 2 is checked if question #2 is not answered and both the question and the pre-populated data are printed on the L/IN. If the recipient 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 prepopulated 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 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 income? If yes, list any changes. Provide proof (Examples: award letter, support court orders, etc.)
Question #4 asks for report of unearned income changes.
Block 4 is checked if question #4 is not answered and both the question and the prepopulated 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 prepopulated 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 food stamps 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 report of address change.
Block 5 is checked if the question is not answered, and Question #5 is printed on the L/IN. This question is not prepopulated, but the recipient has space to provide a new address. The recipient need not answer or verify the part of the question about shelter and utility costs. It will not be tracked. The Instructions section states 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 required to pay? If yes, list any changes. Provide copy of support court order or letter and proof of payment.
Question #6 asks for report of support amount paid for children outside the household.
This question is not required to be tracked. It has no corresponding block on the SAR form. The Instructions section states that changes in support paid will affect SNAP benefits and that recipients may receive less or no SNAP benefits if this information is not provided and verified.
This question will only appear on the L/IN 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 a copy of bill or statement from caregiver.
Question #7 asks for report of amount paid for child care or for care of a sick or disabled person.
The Instructions section states 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 only appear on the L/IN 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 (Examples: copy of bank statement, vehicle registration, etc.)
Question #8 asks for report of household resources.
Block 8 is checked if the recipient does not answer either or both questions.
Exception: Do not check this question incomplete regardless of the answers if resource information is not required in the eligibility determination according to Medical Assistance Eligibility Handbook, Section 340.1.
Question #8 and the prepopulated 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 not adequate 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 prepopulated data will be printed on the L/IN.
Reminder: Always narrate any incomplete verification. This will make it easier for CAO and Change Center staff to help recipients with questions about what information they must provide.
Issued August 9, 2008; Reviewed January 31, 2012