If the CAO receives a request for a replacement of an CAOAA check due to the check being destroyed, lost, stolen, or not received before the original check was endorsed and the stop payment was unable to be issued, the CAO must complete these steps:
Schedule an appointment for the recipient to come to the CAO to sign a PA 207, if unable to place a stop payment on the CAOAA check.
Inform the recipient of the need to provide either the police report or incident number along with the police department name, contact officer name, and phone number (if check is $100.00 or greater) at the scheduled appointment.
Obtain a copy of the original CAOAA check and complete the appropriate sections of the PA 207, including the investigation block.
Complete the Lost/Stolen/Forged Check Checklist (PA 1835).
Complete the Treasury Department information sheet (PA 1839). Have the recipient sign the signature verification and signature block. The recipient is required to provide the sample signatures.
Complete the Treasury Department Notarized Forgery Affidavit (PA 1840). Inform the recipient they must sign the affidavit in the presence of a notary.
Have the recipient sign and date the authorization (PA 1839) under the certification to investigate the cashed CAOAA check. The recipient is required to provide the sample signatures.
Have the recipient obtain the notary public seal on the affidavit (PA 1840).
The OTI notary fee is issued to the client's EBT card. The OTI notary fee reason code is 136. If travel is required by the individual to obtain the notary public seal on the affidavit (PA 1840) at the request of the CAO, reimbursement OTI for transportation may be authorized, using reason code 200.
Section 138.42 Transportation required to comply with an operational requirement.
The CAO should forward the original signed PA 207, information sheet (PA 1839) and notarized forgery affidavit (PA 1840) along with a copy of the original CAOAA check and the lost/stolen/forged check checklist (PA 1835) to the following address:
Department of Human Services – OIM
Health and Welfare Building Room 422
PO Box # 2675
Harrisburg, PA 17105-2675
NOTE: Direct questions to OIM-HQ at RA-OIMHQ@state.pa.us.
Retain the original lost/stolen/forged check checklist, a copy of the PA 207, the CAOAA check, information sheet, and affidavit in the case record.
Process an OTI for a replacement of the EFAA check.
NOTE: If the recipient fails to sign the PA 207 or affidavit, no future replacement CAOAA checks will be processed until the PA 207 and affidavit are signed.
Revised March 6, 2019 , replacing August 12, 2016