SI BOS02003.006 Vermont Interim Assistance Reimbursement Agreement

See SI 02003.000 ff

A. Introduction

On November 29, 1974 the Vermont Department of Prevention, Assistance, Transition, and Health Access (PATH) entered into an Interim Assistance Reimbursement (IAR) Agreement with the Social Security Administration (SSA). This agreement was updated and renewed on March 9, 2001. The IAR Agreement covers both initial and posteligibility situations.

B. Policy

1. Initial and Posteligibility Periods Covered

The IAR Agreement with the Vermont Department of Prevention, Assistance, Transition, and Health Access provides for reimbursement to PATH for assistance provided to the SSI recipient for initial claims and posteligibility situations. For initial claims the reimbursement covers the assistance paid for the interim period while the SSI application is pending. For posteligibility situations the reimbursement covers the assistance paid by DSS to an individual for the interim period while his/her SSI benefits are suspended or terminated if the individual is subsequently found to be eligible for SSI during those months. The interim period is described in SI 02003.001.

2. Protective filing

The IAR authorization serves as a protective filing for an initial SSI claim. The date that PATH receives a signed IAR authorization establishes a 60-day protective filing period for SSI eligibility. If an individual does not file an SSI application within the 60-day protective filing period, the IAR authorization does not serve as protective filing for SSI purposes.

3. Life of the Authorization

For initial SSI claims the IAR authorization is binding on the State of Vermont and an individual for one calendar year beginning with the date SSA receives a signed authorization. If the State of Vermont does not notify SSA within thirty (30) calendar days of the date that the individual signed the authorization, the authorization is no longer binding. In such a situation, SSA will release a retroactive SSI payment to the individual and the State of Vermont will be responsible for pursuing recovery of IAR from the individual without assistance from SSA. If an individual applies for SSI within the one calendar year period covered by the IAR authorization or has already applied for SSI before SSA received an authorization, the period for the life of the authorization will be extended beyond the one year period, until such time as:

  • SSA releases the retroactive payment; or

  • SSA makes a final determination (including a determination on appeal) and no timely request for review is filed; or

  • The State and the individual agree to terminate the authorization.

For initial posteligibility cases, the IAR authorization is binding for one calendar year beginning with the date SSA receives a signed authorization. If the State does not notify SSA within thirty (30) calendar days of the date that the individual signed the authorization, the authorization is no longer binding. In such a situation, SSA will release the retroactive SSI payment to the individual and the State of Vermont will be responsible for pursuing recovery of IAR from the individual without assistance from SSA. If a timely request for administrative or judicial review is filed the IAR authorization remains in effect until such time as:

  • SSA makes the first posteligibility payment of retroactive SSI benefits following the suspension or termination of the individual's benefits; or

  • SSA makes a final determination on the issue and no timely request for appeal is filed; or

  • The State of Vermont and the individual agree to terminate the authorization.

The Vermont Prevention, Assistance, Transition, and Health Access must obtain another initial claim or posteligibility authorization if the authorization is no longer in effect and the State wants to be reimbursed for General Assistance payments made.

C. Process

Vermont PATH uses two IAR authorization forms, one covering initial payment (PATH 230 R 10/00 Authorization for Interim Assistance Reimbursement, Initial SSI Claim) and another covering posteligibility payment (PATH 230A R 10/00 Authorization for Interim Assistance Reimbursement, Reinstated SSI) (Exhibits 1 and 2). Each time an individual files for SSI or his/her benefits are suspended or terminated another initial claim or posteligibility authorization is required.

D. Procedure

When an IAR authorization is received, input the Grant Reimbursement (GR) code for the Vermont Prevention, Assistance, Transition, and Health Access to the SSR.

      GR Code PATH: 47110

Mail manually prepared SSA-L8125s and SSA-L8125-F6s to:

AHS/DCF Business Office
DCF Accounting Unit
103 S Main St, Osgood 1
Waterbury, VT 05671-3711

E. Exhibits

The following exhibits consist of Interim Assistance examples of the Vermont Prevention, Assistance, Transition, and Health Access Authorization and copies of the apportionment notices sent by the State of Vermont.

1. Exhibit 1 — Vermont Prevention, Assistance, Transition, And Health Access Reimbursement Authorization, Initial SSI

Vermont Department of Prevention,                              PATH 230

Assistance, Transition, and Health Access                      R 10/00

Authorization for Interim Assistance Reimbursement

(Initial SSI)

Applicant's Name_______________________________________________________

Address________________________________________________________________

Phone number _____________ Social Security# __________________________

If I am found eligible to receive Supplemental Security Income (SSI) benefits, I authorize the Commissioner of the Social Security Administration (SSA) to send to the Vermont Department of Prevention, Assistance, Transition, and Health Access (PATH) my first retroactive payment of SSI benefits, or an amount equal to the amount of reimbursable public assistance PATH paid to me, in the manner required by law.

PATH may reimburse itself from my first retroactive SSI payment the sum of all state public assistance benefits PATH made to me or on behalf of me as follows: PATH will determine the amount of its reimbursement by adding together each assistance payment I received beginning with the first day of the month that I am found eligible for an SSI payment and ending with the month my SSI payments began, not including assistance financed wholly or in part by federal funds.

I understand that after making the deduction for reimbursement, PATH shall pay me the balance, if any, within 10 days of receiving my first SSI payment. Along with the payment of the balance, PATH will send me a written notice explaining the reimbursement amount PATH kept, the balance PATH is paying to me, and my right to a fair hearing before the Vermont Human Services Board if I disagree with any action PATH took regarding my interim assistance reimbursement payment or this authorization.

I understand that this authorization is only binding on PATH or me if PATH notifies SSA of it within 30 calendar days of the date I signed it. I understand it is effective for one year from the date PATH receives the signed form from me. If I have already filed for SSI, or I file for SSI within one year after signing this form, or I file a timely request for administrative or judicial review under SSA's regulations, however, this authorization will remain in effect until:

  • SSA makes the initial SSI payment on my initial claim; or

  • SSA makes a final determination on my claim; or

  • PATH and I both agree to terminate this authorization.

I further understand that this signed authorization means that I have applied or I intend to apply for SSI benefits to determine if I am eligible. I understand that if I am found eligible for SSI benefits, my eligibility for SSI can begin as early as the date I return this form to PATH, as long as I file the SSI application within 60 days of the date of signing the form.

I also understand that for this authorization to be binding on the state and me, it must be signed and dated by both me and a representative of PATH.

_______________________________________ ______________________

Applicant's signature                                            Date

_______________________________________ ________________________

Worker's signature and district office                    Date received

Distribution: white – SSA; yellow – PATH, Admin. Srvs; pink – applicant; gold – district file

2. Exhibit 2 — Vermont Prevention, Assistance, Transition, And Health Access Reimbursement Authorization, Reinstated SSI

Vermont Department of Prevention,                              PATH 230A

Assistance, Transition, and Health Access                     R 10/00

Authorization for Interim Assistance Reimbursement

(Reinstated SSI)

Applicant's name__________________________________________________

Address ___________________________________________________________

Phone number ______________ Social Security # ____________________

If I am found eligible to receive Supplemental Security Income (SSI) benefits, I authorize the Commissioner of the Social Security Administration (SSA) to send to the Vermont Department of Prevention, Assistance, Transition, and Health Access (PATH) my first retroactive posteligibility payment of SSI benefits, or an amount equal to the amount of reimbursable public assistance PATH paid to me, not including assistance financed wholly or in part by federal funds,in the manner required by law.

PATH may reimburse itself from my first retroactive SSI payment the sum of all state public assistance benefits PATH made to me or on behalf of me as follows: PATH will determine the amount of its reimbursement by adding together each assistance payment I received beginning with the first day of the month that I am found eligible for an SSI payment and ending with the month my SSI payments began, not including assistance financed wholly or in part by federal funds.

I understand that after making the deduction for reimbursement, PATH shall pay me the balance, if any, within 10 days of receiving my first SSI payment. Along with the payment of the balance, PATH will send me a written notice explaining the reimbursement amount PATH kept, the balance PATH is paying to me, and my right to a fair hearing before the Vermont Human Services Board if I disagree with any action PATH took regarding my interim assistance reimbursement payment or this authorization.

I understand that this authorization is only binding on PATH or me if PATH notifies SSA of it within 30 calendar days of the date I signed it. I understand that this authorization is effective for one year from the date PATH receives the signed form from me. If I file, or already have filed, a timely request for an administrative or judicial review under SSA's regulations, however, this authorization will remain in effect until:

  • SSA makes the initial SSI posteligibility payment following a suspension or termination of my SSI benefits; or

  • SSA makes a final determination on my claim and I do not file a timely request for review; or

  • PATH and I both agree to terminate this authorization.

I also understand that for this authorization to be binding on the state and me, it must be signed and dated by both me and a representative of PATH.

_______________________________________________________________

Applicant's signature                                                 Date

_____________________________________________________________________

Worker's signature and district office                          Date received

Distribution: white – SSA; yellow – PATH, Admin. Srvs.; pink – applicant; gold – district file

3. Exhibit 3 — Copy Of The Apportionment Notice Sent By The State Of Vermont When There Is Money Due To The Recipient

State of Vermont                                      AGENCY OF HUMAN SERVICES

Department of Social Welfare

                                                                 Administrative Services Division

                                                                 103 South Main Street

                                                                 Waterbury, Vermont 05671-1201

                                                                 Tel: (802) 241-2835

The department of Prevention, Assistance, Transition and Health Access has received a lump sum check for $ under the Supplemental Security Income Program based on the Interim Assistance Agreement, which you signed.

The Department of Prevention, Assistance, Transition and Health Access has paid you a recoverable total of $ under the General Assistance program to cover your needs from the date of application until your first check was received. Enclosed is a list of payments made to you during this period.

You will receive a state check within the next few business days in the amount of $ . This is your share of the check after deducting payments made to you under the agreement you signed.

Thank you,

ACCOUNTANT

Enc.: Interim Assistance Agreement Accounting of Payments

4. Exhibit 4 — Copy Of The Apportionment Notice Sent By The State Of Vermont When There Is No Money Due To The Recipient

 

State of Vermont                                    AGENCY OF HUMAN SERVICES

Department of Social Welfare

                                                               Administrative Services Division

                                                               103 South Main Street

                                                               Waterbury, Vermont 05671-1201

                                                               Tel: (802) 241-2835

The department of Prevention, Assistance, Transition and Health Access has received a lump sum check for $ under the Supplemental Security Income Program based on the Interim Assistance Agreement, which you signed.

The Department of Prevention, Assistance, Transition and Health Access has paid you a recoverable total of $ under the General Assistance program to cover your needs from the date of application until your first check was received. Enclosed is a list of payments made to you during this period.

Since your General Assistance payments exceeded your Supplemental Security Income payments, ther is no balance due to you from this check.

Thank you,

ACCOUNTANT

Enc.: Interim Assistance Agreement Accounting of Payments


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502003006BOS
SI BOS02003.006 - Vermont Interim Assistance Reimbursement Agreement - 07/05/2006
Batch run: 05/09/2011
Rev:07/05/2006