TN 1 (03-12)

SI 02002.060 Interim Assistance Reimbursement (IAR) Exhibits

We included Exhibits I and II as a reference for reviewing IAR exception cases.

  1. Exhibit I - Example of calculating total IAR due - initial claim

  2. Exhibit II - Example of calculating total IAR due –posteligibility case with proration month

  3. Exhibit III - Sampling Design for IAR

  4. Exhibit IV - IAR Sample Review Worksheet

  5. Exhibit V - IAR Sample Review Summary Sheet

A. Exhibit I — Example of calculating total IAR due—initial claim

State Interim Assistance Paid — $1,200.00

April

May

June

July

August

September

2010

2010

2010

2010

2010

2010

$200

$200

$200

$200

$200

$200

 

Total

 

$1,200

 
SSI Money Available for Reimbursement to the State

April

May

June

July

August

September

2010

2010

2010

2010

2010

2010

$0

175*

175*

0**

368

368

April is E02 month (first month of eligibility, no payment due)

  

*Can recover an additional $25.00 for May and June from the August SSI payment.

  

** Not eligible for SSI in July

Total

 $1,086 
IAR Amount Due the State

April

May

June

July

August

September

2010

2010

2010

2010

2010

2010

$0

200*

200*

0

200

200

*Includes $25 from the August SSI Payment

Total $800 

The State can recover the $200 paid for May, June, August, and September. The State cannot recover any money for April since the claimant was not eligible to receive an SSI payment in April (E02 month). The State cannot recover any money for July since the claimant was not eligible for an SSI payment. The recipient is eligible to receive $286.00 of the retroactive SSI payment ($1,086 minus the $800 reimbursed to the State).

B. Exhibit II — Example of calculating total IAR due —posteligibility case with proration month

  

State Interim Assistance Paid = $1,680

January

2010

$ 280

 

February

2010

280

 

March

2010

280*

*State did not prorate IA in March

April

2010

280

 

May

2010

280

 

June

2010

280

 

Total

 

$1,680

  

SSI Money Available for Reimbursement to the State

    

January

2010

$0

 

February

2010

0

 

March

2010

201.81*

* Prorated SSI amount due for March

April

2010

368

 
 

May

2010

368

 

June

2010

368

 

Total

 

$1,305.81

  

IAR Amount due the State

    

January

2010

$0

 

February

2010

0

 

March

2010

153.55*

*Prorated IA amount

April

2010

280

 

May

2010

280

 

June

2010

280

 

Total

 

$993.55

The State cannot recover any money for January and February since interim assistance and SSI were not both paid for these months. The State can recover $280.00 for April through June, but can only recover $153.55 for March, the prorated month. A State cannot recover more than the prorated amount for March even if more SSI is available. The recipient is eligible to receive $312.26 of the retroactive payment ($1,305.81 minus $993.55).

C. Exhibit III — Sampling Design for IAR

Randomly select samples from the IAR Activity List. Determine the sample review size based on the IAR population (number of paid cases on the activity list) as follows:

Population

Sample (Percent)

1 - 15 cases

100

16 - 35

95

36 - 55

90

56 - 95

85

96 - 135

80

136 - 155

75

156 - 200

70

201 - 245

65

246 - 285

60

286 - 325

55

326 - 465

50

466 - 565

45

566 - 700

40

701 and over

35

D. Exhibit IV — IAR Sample Review Worksheet

  

                                  IAR SAMPLE REVIEW WORKSHEET

  

STATE_____________ AUDIT YEAR_________ SAMPLE MONTH_________

  

TYPE OF CLAIM: IC_____ PE______

  

SSN________________________ RECIPIENT’S NAME__________________

  

SSI ELIGIBILITY DATE___________ AMOUNT OF IAR PAYMENT_______

  

Month IAR and SSI first paid in the same month _________

  

Is there a copy of a valid authorization form or comparable electronic proof in the State file? Yes/No

  

Is there a copy of the apportionment notice that the State sends the claimant in the State file? Yes/No

  

Do the IA money amounts the State entered on the eIAR screens match the IA money amounts the State

paid to the SSI recipient for the months SSA reimbursed the State? Yes/No

  

Did the State send the apportionment notice within 10 working days of receipt of the IAR money? Yes/No

  

REVIEWER’S COMMENTS

  

____________________________________________________________________

  

____________________________________________________________________

  

____________________________________________________________________

  

____________________________________________________________________

  

REVIEWER’S SIGNATURE____________________________ DATE_________________

E. Exhibit V - IAR Sample Review Summary Sheet

  

                             IAR Sample Review Summary Sheet

  

SAMPLE MONTH_____________________ AGENCY NAME____________________

  

                                    Summary of Cases Reviewed

  

Number of cases reviewed______________ Number of cases that cont