Appendix B: Completion of the OIG 711-C

At the request of the OIG, the CAO is responsible to compute SNAP overissuance claim amounts beyond the 24-month period calculated by the ARRC system. An OIG 711-C, SNAP Overissuance Computation Sheet, must be completed by the CAO for each SNAP overissuance claim requested by OIG. A separate calculation must be made for each month of the period of overissuance unless instructed otherwise. Four monthly issuance and comparative overissuance computations can be put on one OIG 711-C. The SNAP overissuance claim amount is the difference between the total monthly allotments issued to the household and the total monthly allotments that should have been issued to the household during the period of overissuance.

NOTE: If an underissuance occurred for any month(s) during the period of overissuance, the household is entitled to restored benefits. Complete and process a PA 816-SP to the OIG for the underissuance month(s). The OIG offsets the restored benefit amounts against the overissuance amount. Also, the amount of SNAP benefits issued and underissued for such months are disregarded (not taken into account) when the CAO totals the overissuance claim amount on the OIG 711-C.

Once the CAO has completed the OIG 711-C, it should distribute copies of the form as follows:

1.

The CAO makes and retains a copy of OIG 711-C in the case record for four years.

2.

The CAO forwards the original OIG 711-C to the OIG Agent/Investigator requesting its preparation.

All  OIG 711-C forms must be numbered in the upper right corner of the form. If only one  OIG 711-C is required for an overissuance, it is numbered page 1 of 1. If multiple  OIG 711-C forms are required for an overissuance, each form must be sequentially numbered. For example, if three  OIG 711-C forms are needed for computation, the first form is numbered page 1 of 3, the second form is page 2 of 3, and the third form is page 3 of 3.

When an overissuance claim requires more than one  OIG 711-C form, the OIG copies should be put in numerical sequence.

Head of Household

Enter the name of the head of the household.

Case ID

Enter the county and record number, if necessary. Use zeros in front of the record number to increase it to seven digits.

Overissuance Period

Enter the beginning and ending dates of the overissuance period.

Reason for Overissuance

Check the appropriate block for the reason for the overissuance.

Block A.

Total monthly allotments issued – Enter the total amount of SNAP benefits issued and transacted for those months in which an overissuance occurred during the overissuance period (total of all the “A” columns on the computation sheets).

Block B.

Total monthly allotments that should have been issued – Enter the total amount of SNAP benefits that should have been issued for those months in which an overissuance occurred during the period of overissuance (total of all the “B” columns on the computation sheets).

Block C.

SNAP overissuance amount – Enter the total amount of the SNAP overissuance (A minus B).

Block D.

Total amount of restored benefits – Leave blank. (See special instructions regarding “Offsetting” on the back of the  OIG 711-C).

Block E.

Adjusted SNAP overissuance – Leave blank.

Overissuance Month/Year – Enter the appropriate month and year (mm/yy) of overissuance.

Income Month/Year – Enter the appropriate budget month(s) and year from which the actual income and circumstances were and/or should have been considered for the overissuance month/year.

Column A

The element “Number of Persons in Household” and items 1 through 21 in column A are completed using the information that was used to calculate the original monthly SNAP allotment.

Column B

The element “Number of Persons in Household” and items 1 through 21 in column B are completed using the information that was used to calculate the original monthly SNAP allotment and the documentation that verifies the circumstances or reason that caused the overissuance.

Number of Persons in Household – Enter the total number of persons eligible to receive SNAP benefits in the appropriate month.

1.

Gross Earned Income – Enter the total gross monthly earned income of the household.

2.

Gross Unearned Income – Enter the total gross monthly unearned income of the household. Include the cash grant in the column B computation, even if a cash overpayment claim is being referred

3.

Total Gross Income – Enter the total gross monthly income of the household.

4.

Gross Income Limit – Enter the gross income limit for the size of the household.

5.

Earned Income Deduction – Leave blank if the individual does not report earned income timely. See Section 910.472..

6.

Standard Deduction – Enter the appropriate standard deduction at the time of the overissuance.

7.

Total Deductions – Enter the total earned income and standard deductions.

8.

Income After Deductions – Enter the income after the earned income and standard deductions are subtracted.

9.

Medical Expenses – Type – Enter the allowable medical expense type, such as doctor, drugs, insurance, etc. Must list by each type.

10.

Total Medical Expense – Enter the amount for all types of medical expenses listed on line 9.

11.

Total Medical Expense – Enter the amount for all types of medical expenses listed on line 9.

12.

Income After Medical Deduction – Enter the amount of income after the medical deduction is subtracted from income after deductions.

13.

Dependent Care Cost Allowed Up to Total of Maximum per Dependent – Enter the total dependent care cost allowed based on the maximum per dependent in effect at the time of the overissuance.

14.

Income After Dependent Care Deduction – Enter the amount of income after the dependent care deduction is subtracted from income after medical deduction.

15.

Shelter Costs

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Rent or Mortgage – Enter the rent or mortgage cost.

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Taxes – Enter the amount of taxes.

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Insurance – Enter the amount of insurance.

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Utility Standard – Enter the amount of the appropriate utility standard during the overissuance if coded “y.”

ENTER THE FOLLOWING UTILITY COSTS ONLY WHEN THE CLIENT DID NOT CHOOSE THE UTILITY STANDARD:

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Telephone (Basic rate) – Enter the appropriate basic telephone rate for the overissuance period.

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Electric - Enter the amount of the electric bill.

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Gas or Oil – Enter the amount of the gas and/or oil bill.

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Water, Sewer – Enter the amount of the water and/or sewer bill.

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Garbage, Trash – Enter the amount of the garbage and/or trash bill.

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Utility Installation – Enter the cost of installing any utility.

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Other – Enter the amount paid for any other utility not listed above.

16.

Total Shelter Costs – Enter the total of all items listed in line 15 above.

17.

50% of Line 14 – Divide line 14 by two and enter the amount here.

18.

Excess Shelter Cost – Enter the amount of the excess shelter cost.

19.

Shelter Deduction – Enter the amount from line 18 or the maximum allowed, whichever is less.

20.

Net Monthly Income – Enter the net monthly income (lines 14-19).

21.

SNAP Allotment – Enter in column A the amount the household received for the month, and in column B the amount the household should have received for the month.