FNS-366B Part B - Program and Budget Summary Statement

FORM APPROVED OMB NO. 0584-0083
U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

A. STATE

PROGRAM AND BUDGET SUMMARY STATEMENT
PART B - PROGRAM ACTIVITY STATEMENT
(A) APPROVALS

B. REPORT PERIOD (State' s FY)

TO
MO.

YR.

MO.

YR.

(C) OVERDUES

(B) DENIALS

(STATE AGENCY CAUSED)

C. CERTIFICATIONS

NA

PA

NA

PA

NA

PA

HEARINGS
HELD

DECISIONS
UPHELD

DECISIONS
REVERSED

DECISIONS
OVERDUE

(D)PROGRAM
DOLLARS

(E)INVEST.
PENDING

(D) UPHELD
CONVICTIONS

(E)ACTUALLY (F)PROGRAM
ACQUITTED
DOLLARS

1. INITIAL APPLICATIONS
2. EXPEDITED SERVICE APPLICATIONS
3. RECERTIFICATIONS

D. FAIR HEARINGS

HEARINGS
REQUESTED

1. Activity

E. FRAUD INVESTIGATIONS

(A)REFERRED
FOR INVEST.

INVEST COMPLETED
(B)NEGATIVE

(C)POSITIVE

(F)INVEST.
CANCELED

1. PRE-CERTIFICATION

2. POST-CERTIFICATION

F. DISQUALIFICATION HEARINGS
& PROSECUTIONS

(A) CASES
(PERSONS)
REFERRED

(B) CASES
PURSUED

(C) WAIVERS
DISQUALIFICATION CONSENT
AGREEMENT

(G) PENDING
DECISIONS

(H)DECISIONS
OVERDUE

1. ADMINISTRATIVE DISQUALIFICATION HEARING
2. PROSECUTIONS

DATE

SIGNATURE

FORM FNS-366B (4-01) Previous Editions Obsolete

TITLE

Electronic Form Version, Designed in JetForm 5.1 Version

INSTRUCTIONS
FORM FNS-366B
CERTIFICATION: This section identifies the number of initiated,
Expedited Service and Recertification applications that w ere
Approved, Denied or Overdue (SA failed to determine household
eligibility and provide benefits w ithin the processing timeframes
required by regulation). This data shall be categorized as public
assistance (PA) or non-assistance (NA). For this report, PA
applications shall be those that list all household members as
receiving income or benefits from TANF, or income from SSI or
GA (means - tested) program; NA applications shall be those
in w hich at least one household member does not receive income
or benefits from TANF, or income from SSI or GA. The entries in each
line item must be determined independent of the other line item entries.

(B) Investigation Completed, Negative - Enter the number of cases for
w hich an investigation w as completed before the end of the report
period and no indication of a program violation w as found.

(A) 1 through (C) 3: Enter the annual cumulative total number of
NA/PA initial, Expedited Service and Recertification Applications
that w ere Approved, Denied, and Overdue.

(E) Investigations Pending - Enter the number of cases for w hich an
initiated investigation had not been completed before the end of
the report period, or an investigation had not been initiated before
the end of the report period.

FAIR HEARINGS: This section shall provide the results of the
requests for a hearing. The entries in each line item must be
determined independent of the other line item entries.
Line 1 Activity
Hearings Requested - Enter the total number of fair hearings
requested during the report period.
Hearings Held - Enter the total number of fair hearings that w ere
held during the report period.
Decisions Upheld - Enter the total number of fair hearings that
w ere held during the report period that resulted in the State
agency' s action being upheld.
Decisions Reversed - Enter the total number of fair hearings that
w ere held during the report period that resulted in the State
agency' s action being reversed.

(C) Investigations Completed, Positive - Enter the number of cases for
w hich an investigation w as completed before the end of the report
period and referred for an ADH or for Prosecution.
(D) Program Dollars - For the cases reported in item E 2, (C), enter
the potential dollar value of program loss that may be recovered if
the suspected program violation is substantiated by an ADH or the
courts.

(F) Investigations Canceled - Enter the number of cases in w hich an
investigation had been initiated but canceled before the end of the
report period.
F

DISQUALIFICATION HEARINGS AND PROSECUTIONS:

This section reflects action taken on cases referred for an ADH or
prosecution that are accused of committing an IPV. The entries in
each line item must be determined independent of the other line
item entries.
Line 1 - Administrative Disqualification Hearings
(A) Cases (Persons) Referred - Enter the number of cases referred
during the report period.
(B) Cases Pursued - Enter the number of cases for w hich an ADH
w as held during the report period.

Decisions Overdue - Enter the total number of fair hearing decisions rendered during the report period that w ere not made w ithin
the specified timeframes.

(C) Waivers - Enter the number of cases for w hich the accused person signed a Waiver of Right to an ADH during the report period.

E FRAUD INVESTIGATIONS: This section reflects investigation
activity of cases in w hich there is suspicion of an act of intentional program violation (IPV). Such case referrals are identified
as pre-certification or post-certification investigations. Pre-certification investigations are those cases that are referred prior to an
initial application eligibility determination. The entries in each line
item must be determined independent of the other line item entries.

(E) Actually Acquitted - Enter the number of cases for w hich the
hearing officer found the person not guilty of committing an IPV.

Line 1 Pre-Certification

(D) Upheld - Enter the number of cases for w hich the hearing officer
upheld the agency' s suspicion of an IPV.

(F) Program Dollars - For the cases reported in items F 1, (C), and (D),
enter the dollar value of program loss that may be recovered.

(A) Referred for Investigation - Enter the number of pre-certification
applications referred during the report period.

(G) Decisions Pending - Enter the number of cases reported in item
F 1, (B) for w hich the hearing officials decision is not due (w ithin
established timeframes) to be rendered before the end of the
report period.

(B) Investigations Completed, Negative - Enter the number of investigations that w ere completed w ithin the application processing
timeframe and no indication of a program violation w as found.

(H) Decisions Overdue - Enter the number of cases that w ere pursued
in w hich the decisions w ere rendered later than the prescribed
timeframes.

(C) Investigations Completed, Positive - Enter the number of investigated cases that w ere completed w ithin the application processing timeframe that w ere denied eligibility.

Line 2 Prosecutions

(D) Program Dollars - For the cases reported in item E 1, (C), enter the
potential dollar value of benefits the household w ould have
received for the first full month of eligibility if a suspected program
violation had not been detected before the eligibility determination.
(E) Investigations Pending - Enter the number of cases for w hich: an
initiated investigation had not been completed by the end of the
application processing timeframe; an initiated investigation had
not been completed before the end of the reporting period; or an
investigation had not been initiated before the end of the report
period.
(F) Investigations Canceled - Enter the number of cases for w hich an
investigation had been initiated but canceled before the end of
the report period.
Line 2 Post-Certification
(A) Referred for Investigation - Enter the number of initial application
cases that w ere referred for pre-certification investigation and
the investigation w as not completed before the eligibility determination, and all other cases referred for investigation during the
report period.

(A) Cases (Persons) Referred - Enter the number of cases referred for
prosecution by the courts during the report period.
(B) Cases Pursued - Enter the number of cases referred w hich w ere
accepted by the prosecutor during the report period.
(C) Disqualification Consent Agreement - Enter the number of cases
for w hich adjudication is deferred as the accused persons
admitted guilt by signing the Disqualification Consent Agreement
w aiving their right to prosecution by the courts during the report
period.
(D) Convictions - Enter the number of cases found guilty of
committing an IPV by the courts during the report period.
(E) Actually Acquitted - Enter the number of cases found not guilty of
committing an IPV by the courts during the report period.
(F) Program Dollars - For the cases reported in items F 2, (C), and (D),
enter the estimated dollar value of program loss that may be
recovered.
(G) Decisions Pending - Enter the number of cases for w hich the
cases w ere heard but the court' s decision w as not formally
rendered before the end of the report period.

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