The CAO will have the individual sign a reimbursement form when the individual expects to receive personal property subject to reimbursement. See Appendix A for reimbursement requirements for specific types of personal property.
The CAO will use the following forms to secure reimbursement:
Agreement and Authorization to Pay Claim (FIRM 176-K) – reimbursement of most personal property. See Section 915.51, “Agreement and Authorization to Pay Claim (FIRM 176-K).”
Agreement and Authorization to Pay Medical Assistance Claim (HS 176-KM) – recovery of medical assistance payments when a third party is liable for injuries to the individual. See Section 915.52, “Agreement and Authorization to Pay Medical Assistance Claim (HS 176-KM).”
Agreement for Repayment of Delayed UC Checks (OIG 176-U) – reimbursement of delayed UC checks resulting from a claim where all or part of the employment is in Pennsylvania. See Section 915.531, “Agreement for Repayment – Delayed UC Checks (OIG 176-U).”
Authorization for Reimbursement of Assistance (OIG 176-SSI) – reimbursement of GA received while an SSI application is pending. See Section 915.541, “Authorization for Reimbursement of Assistance (OIG 176-SSI).”
Assignment of Interest in Decedent’s Estate (PA 198-S) – reimbursement of an inheritance. See Section 915.55, “Inheritance of Personal Property (PA 198-S).”
55 Pa. Code § 257.24(c)(2)(iii)
The CAO will obtain the liable individual’s signature immediately when the CAO learns of a potential reimbursement claim. The CAO will:
1. Fill in the blank space on the FIRM 176-K following “pending receipt of money from” with the appropriate phrase from Appendix A, “Reimbursement Chart.”
2. Give a copy of the form to the individual.
3. Refer the FIRM 176-K to the OSIG immediately. See Section 915.71, “Preparation and Submission of the OIG 173-S.”
NOTE: If the FIRM 176-K is used for Unemployment Compensation claims listed as an exception in Section 915.531 then the 176-K will be mailed directly to Labor and Industry. See Section 915.531.
4. Notify the OSIG immediately if the individual reports the receipt of reimbursable personal property and has all or some money to pay the claim. See Section 915.62, “Exchange of Information by Telephone.”
If an individual receives MA for services which should be covered under private health insurance or by some other person, the Department has the right to recover that third party payment. The third party resource must be used to the fullest extent possible before the Department pays for a service. MA is the payor of last resort.
55 Pa. Code § 178.6 62 P.S. 1409
This provision applies to both Cash and MA recipients who use MA to pay for medical expenses that could be covered by a third party.
If an individual requires medical services related to an injury in an automobile, at work, or some other accident, such as a fall which would be covered by homeowner’s insurance, or if the injury is caused by the negligence of a liable third party such as medical malpractice or product liability, the CAO will:
1. Obtain verification about the injury from the individual.
2. Fill in the blank space with the phrase from Appendix A, “Reimbursement Chart” and obtain the individual’s signature on the HS 176-KM.
NOTE: The individual also must sign the FIRM 176-K if the individual is receiving cash benefits.
3. Refer the HS 176-KM (and the FIRM 176-K, if appropriate) to the TPL-Casualty Unit in BFO. See Section 915.611, “Preparation and Submission of the OIG 173-S.”
4. Update the case record and the Third Party Liability File to indicate coverage.
UC is considered delayed if it is received later than the normal payment date. Reimbursement is required for cash benefits received pending receipt of the delayed UC. See Appendix A, “Reimbursement Chart.”
The normal time period for processing a UC claim includes a waiting week, a compensable week, a reporting week, and the mailing of the check. The claimant receives the benefits three to four weeks after initially filing the application for UC benefits. If the claimant does not receive the UC check within this time period, it is considered delayed.
The claimant’s Office of Employment Security (OES) Identification Card (ES-350) shows the following information:
BYB – Benefit Year Begins – This is the Sunday before the claimant signs for the waiting week.
BYE – Benefit Year Ends – This is the last date in the benefit year and is always a Saturday.
WW – Waiting Week – This is the first week a claimant is eligible to receive benefits. No UC is issued for this week. There is only one waiting week per claim.
First CWE – First Compensable Week Ending – The first eligible week of UC for which a UC check is issued. The date is always a Saturday.
Next Reporting Date – The next date the claimant is to sign for benefits.
Example: The recipient is laid off from their job at Joni’s Fitness Center on 03/08. On 03/13, they open a UC claim. Their reporting date is Tuesday. Their benefit year will begin 03/11. They have not been unemployed for a full week (Sunday through Saturday) on 03/13, so they do not actually sign for benefits.
On 03/20, the recipient signs for their waiting week (WW 03/17) and is given a next reporting date of 03/27. On 03/27, they sign for their first compensable week (CWE 03/24). They should receive their first UC check by 04/03.
The CAO will use the OIG 176-U when all or part of the employment is in Pennsylvania.
Exception: The CAO will use the FIRM 176-K if the UC is from:
Employment outside Pennsylvania;
Federal Employee Unemployment Compensation;
Railroad Unemployment Compensation; or
Veteran’s Unemployment Compensation.
To complete the OIG 176-U, the CAO will:
1. Explain to the individual that the OIG 176-U has a limited Power of Attorney clause which enables the OSIG to collect delayed UC checks to repay cash benefits. The OSIG will deduct the cash benefits owed and refund the excess to the individual.
2. Obtain the UC claimant’s signature.
3. Prepare the OIG 176-U according to the instructions on the reverse side of the form. Obtain any needed information from the individual and/or from the UC forms.
Important: The form must have the correct Social Security number of the UC claimant.
4. Mail the OIG 176-U or the Firm 176-K to:
UI Payment Services
Labor and Industry
Room 501, Boas Street
Harrisburg PA 17105
When the individual signs the OIG 176-U, the OES intercepts the UC checks and notifies the OSIG.
The OSIG will determine:
The amount of reimbursement owed;
NOTE: The reimbursement period begins the date the UC was originally due and ends the date of expected closing of the case or adjustment of UC. The amount of the claim is the lesser of cash benefits subject to reimbursement or all reimbursable UC checks.
The amount due the individual; and
The effective date of discontinuance or adjustment of cash benefits.
OES will provide the OSIG with a print-out of available checks. The OSIG will subsequently advise OES of the appropriate number of checks needed to repay the claim. Within 20 calendar days, the OSIG will issue a refund of any excess collection to the individual and provide the individual and the CAO with an Over-Recovered Benefit Invoice (OIG 128). This refund check will not appear on the assistance transcript inquiry screen.
Attached to the OIG 128 is the OES printout listing the UC checks by CWE dates. The OSIG will highlight those checks that OES intercepts for repayment of cash benefits. The OIG 128 will notify the CAO of the effective date of the case closing or adjustment. The CAO will take prompt action, with proper notice, to close or decrease the cash budget on the same effective date specified on the OIG 128.
The CAO will not take budget action until it receives the OIG 128. If the individual reports notification by OES that benefits are forthcoming, the CAO will contact the OSIG at 1-800-932-0935 to determine the status of the OIG 176-U.
The effective date shown on the OIG 128 is the end of the reimbursement period for which the OSIG collected reimbursement. An overpayment or underpayment will occur if the CAO closes or adjusts the case on a different effective date.
The CAO may refer any individual’s questions about the claim or the refund to the OSIG. The OSIG phone number is listed on the front of the OIG 128.
If the OIG 176-U lacks information or contains incorrect information, the OSIG will return the OIG 176-U with the FAIR 176-U Follow-Up (FAIR 50) to the CAO.
If an individual reports that a refund was not received, the CAO will:
1. Obtain the individual’s signature on a Request for Investigation/Waiver of Investigation of Check (PA 207)
NOTE: The missing check will not appear on the assistance transcript inquiry screen because the OSIG directly prompts the issuance of the Treasury check.
2. Explain to the individual that the PA 207 initiates an investigation by the OSIG to determine whether the refund check was cashed, and, if so, by whom. The OSIG will complete an investigation and issue a replacement if the investigation shows that the individual did not cash the original check.
3. Send all copies of the PA 207 to:
OSIG
SSI/UC Refund Unit
P.O. Box 8016
Harrisburg, PA 17105-8016
An individual has a right to an inheritance beginning the date of death of the person from whom the individual inherits. Cash benefits received after that date are reimbursable. The CAO will:
1. Obtain the individual’s signature on the PA 198-S. The individual will sign their full name or their name as it appears in the will, if there is one.
NOTE: Send a memorandum to the OSIG for advice if the liable heir is a minor.
2. Send the original Assignment of Interest in Decedent’s Estate and duplicate to the OSIG. The CAO will provide the following:
A copy of the will, if any;
The name and address of the administrator and attorney, if any; and
Any other pertinent information.
3. Give a copy of the PA 198-S to the individual.
Current regulations treat life insurance as a resource. However, regulations prior to 11/7/81 allowed an individual whose resources exceeded the limit to assign the life insurance policy to the Commonwealth. The Assignment of Insurance (PA 6-F) or the insurance company’s form for total assignment may be used for verification. An Assurance as to Non-Change of Beneficiary (PA 6-F) may also be attached to verify that the beneficiary may not be changed again.
The CAO will submit a referral to the OSIG when:
A person whose life insurance is assigned to the Department dies; or
An individual requests release of the assignment.
Updated January 3, 2024, replacing March 14, 2019