*F1-1 MM/DD/YY (date printed on the correctional institution’s incentive payment (IP)
notice which contains the incorrect IP we must recoup). NOTE: We place a copy of each correctional institution’s IP notice on the Online Retrieval
System (ORS) when we pay an institution an IP. The IP notice provides the institution
with information on the total IP deposit and it includes detailed information about
each IP included in the deposit.
*F2-1 $xxxx.00 (Dollar amount) (total dollar amount of deposit on the correctional
institution’s IP notice)
*F3-1 $xxxx.00 (Dollar amount) (amount of the incorrect IP)
*F4-1 your institution confined our beneficiary for 30 continuous days or less.
*F4-2 your public institution confined our recipient for less than one full calendar
month.
*F4-3 the prisoner in your institution was not our beneficiary.
*F4-4 the prisoner in your institution was not our recipient.
*F4-5 the incentive payment belongs to another correctional institution.
*F5-1 our beneficiary’s early release from your institution
*F5-2 our recipient’s early release from your institution
*F5-3 the inmate’s actual identity
*F5-4 the other correctional institution’s misrouted incentive payment
*F6-1 The information for this incorrect incentive payment is:
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•
Social Security Number: XXX-XX-XXXX (last 4 digits of incorrectly paid SSN from correctional
institution’s IP notice)
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•
Inmate ID: XXXXXXXXXX (10 numeric digits)
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•
Payment: $XXX.XX (either $400.00 or $200.00)
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•
Report Date: MM/DD/YY (e.g., 09/01/14)
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•
Receipt Date: MM/DD/YY (e.g., 09/30/14)
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•
Date Confined: MM/DD/YY (e.g., 08/02/14)
(We will extract information for F6 for the incorrectly paid IP from the correctional
institution’s IP notice.)
*F7- (XX-XXXXXXX) (9 numeric digits) EIN for facility/reporter (We obtain this information
from the Incarceration Reporting Control System (IRCS) Incentive Payment Identification
Query (QPID) Screen.