Appendix A: Reimbursement Chart

Personal Property

ALIMONY PAYMENTS

Normal payment (due) date.

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed (specify) payments.

BLACK LUNG BENEFITS

Retroactive benefit.

Delayed benefit.

Date of entitlement.

Normal payment (due) date.

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed black lung benefits.

DELAYED PAYMENTS OR WAGES

Normal payment (due) date.

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed Payment or Wages.

INHERITANCE

Date of death of the person who owned the property.

PA 198-S

MORTGAGES, JUDGMENTS, TRUST FUNDS, LEASES, ETC.

Date acquired.

Assignment. Send memo to OSIG to prepare assignment.

PENSIONS OR RETIREMENT FUNDS

Normal payment (due) date.

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed Payment or Wages.

PERSONAL DAMAGE CLAIMS AND AWARDS

A claim resulting from injuries to a person.

Date of injury. When an award is made to a minor, reimbursement required only for assistance to or for the minor; if to an adult, calculate in usual way.

From that part of the award paid for burial and medical costs arising from injury and not otherwise paid and cost of collecting the damages.

Assignment. Send memo to OSIG to prepare assignment.

RAILROAD RETIREMENT OR UNEMPLOYMENT BENEFITS

Single final payment.

Periodic payments.

Normal payment (due) date.

Normal payment (due) date.

If paid before 1st payment day after normal due date.

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed railroad retirement benefits.

SICK BENEFITS

Normal payment (due) date.

Benefits paid for medical or burial costs and costs of collecting the benefits.

FIRM 176-K *Delayed sick benefits.

SOCIAL SECURITY RETIREMENT, SURVIVOR’S AND DISABILITY INCOME BENEFITS (RSDI)

Retroactive benefit.

Delayed benefit.

Date of entitlement.

Normal payment (due date)

If paid before 1st payment day after date of entitlement.

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed social security retirement, survivor’s or disability benefits.

STATE EMPLOYEES RETIREMENT SYSTEM BENEFITS

Single final/periodic payment.

Paid to beneficiary.

Normal payment date (6 weeks from date of separation).

Normal payment date (7 weeks from date of employee’s death).

If paid before 1st payment day after normal due date.

If paid before 1st payment day after normal due date. Reimbursement is not required from that part of the resource used to pay burial or last medical expense.

If paid before 1st payment day after normal due date.

If paid before 1st payment day after normal due date. Reimbursement is not required from that part of the resource used to pay burial or last medical expense.

SUPPLEMENTAL SECURITY INCOME (SSI)

Retroactive benefit.

Delayed benefit.

Date of entitlement.

Normal payment (due) date.

If paid before 1st payment day after date of entitlement.

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed SSI benefits.

UNEMPLOYMENT COMPENSATION

Pennsylvania employment.

Out-of-State employment.

Normal payment (due) date (7 days after sign date).

Normal payment (due) date (7 days after sign date).

If paid before 1st payment day after normal due date.

FIRM 176-U.

FIRM 176-K *Delayed unemployment compensation.

VETERANS BENEFITS AND PENSIONS

Retroactive benefit.

Delayed benefit.

Date of entitlement.

Normal payment (due) date.

If paid before 1st payment day after date of entitlement.

If paid before 1st payment day after normal due date

FIRM 176-K *Delayed Veteran's benefits.

VOCATIONAL TRAINING PAYMENTS

Normal payment (due) date (7 days after the end of the compensable training week).

If paid before 1st payment day after normal due date.

FIRM 176-K *Delayed training payments.

WORKER’S COMPENSATION

Periodic benefits.

Lump-sum award.

Normal payment (due) date (end of 2nd week following injury).

Date of injury.

If paid before 1st payment day after normal due date.

From that part of benefits paid for medical/burial costs arising from illness and not paid and costs of collecting the benefit.

FIRM 176-K *Delayed worker’s compensation.

* Insert phrase on FIRM 176-K.