An individual who is liable for reimbursement of cash benefits must acknowledge that liability in writing by signing a reimbursement form. The reimbursement form is the individual agreement to repay the Commonwealth when the individual acquires the personal property. Only the individual who is liable for reimbursement is required to sign a reimbursement form.
55 Pa. Code § 257.24(a)(1)(ii) 55 Pa. Code § 257.24(a)(2)(iii)
An individual is liable for reimbursement of assistance whether or not the individual signs a reimbursement form.
An applicant who is awaiting receipt of reimbursable personal property must sign a reimbursement form for cash benefits. The applicant must sign the form before the CAO authorizes cash benefits for them, their spouse, or unemancipated minor children living with them. The CAO will obtain the signature(s) on the reimbursement form during the application process or before issuing the first check.
A recipient must sign a reimbursement form for cash benefits whenever the recipient will acquire reimbursable personal property. If the recipient refuses to sign a reimbursement form, the CAO will:
discontinue cash benefits; and
refer the claim to the TPL-Casualty Unit in BFO or to the OSIG. See Section 915.6, “Referral to the TPL-Casualty Unit in BFO or to the OSIG.”
An adult who is declared incompetent by a court is prohibited from signing a reimbursement form. Only a court appointed guardian or court appointed representative may sign, and only with the authorization of the court which appointed the guardian or representative. The guardian or representative must initiate the necessary court action. The CAO will authorize cash benefits pending the court’s permission for the guardian or representative to sign. The CAO will allow sufficient time to complete the process.
If the parent, guardian, or representative refuses to sign or request authority to sign, the CAO will:
authorize cash benefits for the minor or incompetent adult if otherwise eligible; and
notify the OSIG by memorandum. See Section 915.63, “Exchange of Information by Memorandum.”
If the court refuses to grant the necessary authority or if there is no guardian or representative the CAO will:
authorize cash benefits if the minor or incompetent adult is otherwise eligible;
notify the OSIG by memorandum. See Section 915.63, “Exchange of Information by Memorandum,” and
take action on reimbursement as instructed by the OSIG.
Updated January 3, 2024; replacing March 14, 2019