Quality Control Review Schedule

FNS HANDBOOK 310

INSTRUCTIONS FOR COMPLETING FORM FNS 380-1,
QUALITY CONTROL REVIEW SCHEDULE
GENERAL INFORMATION
The Quality Control Review Schedule (QCRS) is the data entry form to record the
results of Food Stamp Quality Control reviews.
The schedule consists of seven sections:
1 - Review Summary
2 - Detailed Error Findings
3 - Household Characteristics
4 - Information on Each Household Member
5 - Income Identified by Household Member
6 - Reserved Coding
7 - Optional - For State Use
All entries in the QCRS are dollar amounts, dates, or numeric codes.

Dates - Use six or eight-digit numbers as the entry requires. For example,
October 3, 2003 would be coded:

1 0 0 3 2 0 0 3

The October sample month would be coded:

1

0 2 0 0 3

Dollar Amounts - Round all dollar amounts to the nearest dollar; leading zeros are
not required. For example, $165.00 is entered:

1

6 5

Not Applicable – If an item does not apply to the case reviewed, leave the applicable
boxes blank:

Unknown - If an item is known to exist but the specific amount is not known, fill in
all boxes for that item with 9’s:

9 9

9 9

If no information is available or if the item does not apply to the household, leave the
boxes blank. Do not enter zeros to indicate no information.

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Stratum - States with stratified samples should submit to the FNS regional office a
listing of the numeric codes utilized to identify stratum. Stratum codes are assigned
by the State agency when the sample is stratified. If stratum codes are not used,
leave blank or enter other identifying information at State option.

Local Agency Code – This code is used to group data by county or county
equivalent or smaller areas. The system requires a three-digit code.
The State may use Federal Information Processing Standards (FIPS) codes or use an
alternative method to designate local agency. Once a State has selected a method,
submit to the FNS regional office a listing of the local agencies and corresponding
codes.
FIPS Codes – The National Institute of Standards and Technology has developed
codes for classification of counties and county equivalents. These codes were
devised by listing counties alphabetically and assigning sequentially odd integers;
e.g., 001, 003, 005.

QUALITY CONTROL REVIEW SCHEDULE
SECTION 1 - REVIEW SUMMARY
This section records the final determination of the QC review. It is used to compute
the States payment error rate.

1. QC Review Number - Enter the number assigned to the Quality Control
review.

2. Case Number - Enter the number assigned by the local agency to the household
that was certified and has been reviewed.

3. State code - Enter the two digit State code from the following list of codes of
National Institute of Standards and Technology.

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State Codes - National Institute of Standards and Technology
State

Code

State

Code

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri

01
02
04
05
06
08
09
10
11
12
13
66
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming

30
31
32
33
34
35
36
37
38
39
40
41
42
44
45
46
47
48
49
50
78
51
53
54
55
56

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4.

Local Agency Code – Enter the three-digit code designating the local

agency for this case.

5.

Sample Month and Year - Enter the month and year for which the case
eligibility and benefit level were reviewed.

6.

Stratum - Enter the two-digit stratum codes if sampling is stratified. If not
stratified enter a State optional code or leave blank.

7.

Disposition - Enter one of the following codes:
1 - Complete
2 - Not subject to review
3 - Incomplete
4 - Case deselected
If codes 2, 3, or 4 are used, no further entries are required on the remainder of
the review schedule except item 68, reserved code for Timeliness of
Application Processing (Expedited and 30 Day Requirement).

8. Review Findings - Enter one of the following codes:
1 - Amount correct
2 – Overissuance
3 - Underissuance
4 – Ineligible
Do not complete sections 4 and 5 if code 4, ineligible, is used.

9. FS Allotment Under Review - Enter the authorized amount of food stamps
subject to review for the sample month.

10. Error Amount - Enter the dollar amount of any identified error. The dollar
amount of the error is the difference between the benefits the State
authorized and the benefits the State should have authorized. Use the lower
error amount from comparison one or comparison two.
•

For overissuance or underissuance errors, enter the error amount for those
with errors exceeding $25.00.

•

For ineligible errors, enter the full amount of the error.

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11. Case Classification - Enter one of the following codes:
1 – Included in error rate calculation.
2 – Excluded from error rate calculation - processed by SSA worker.
3 – Excluded from error rate calculation, as designated by FNS (e.g. demo
project, simplified FSP).

SECTION 2 – DETAILED ERROR FINDINGS
This section provides for the detailed coding of each variance identified during the QC
review. If additional lines are needed to code error findings, attach an additional
page. Since the information recorded in this section is the basis for corrective
actions, the accuracy of the information is important. If more than one variance is
identified, the variance that the agency believes is most significant in leading to the
error should be listed first.

12. Element - Enter the appropriate element number of the review for each
variance identified.

13. Nature codes - Enter the appropriate code for the nature of each variance.
The following provides the element and nature codes to be used in items 12
and 13.
These nature codes may be used in any element:
Nature code (98) - Transcription or computation errors.
Nature code (99) – Other. Use this nature code in the following situations:
a) If no specific nature code is listed under an element,
b) If the nature of the error is clearly understood by looking at the
agency/client code recorded for the error, or
c) If none of the listed nature codes under an element apply to the
error being recorded.

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BASIC PROGRAM REQUIREMENTS – (100)
Element 111 - Student Status
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 130 - Citizenship and Non-Citizen Status
Nature codes:
Citizens
6 - Eligible person(s) excluded
7 - Ineligible person(s) included
124 - Variance resulting from use of automatic Federal information exchange
system
Non-Citizens
200 – Eligible non-citizen excluded
201 – Ineligible non-citizen included
124 – Variance resulting from use of automatic Federal information exchange
system

Element 140 - Residency
Nature codes:
99 - Other

Element 150 - Household Composition
Note: Variances should be coded under this element if a person or persons are
unreported or incorrectly reported, unprocessed or incorrectly processed, and
these persons also have income, resources or deductible expenses, which must be
considered in the error determination.

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For example: the discovery of an unreported 62 year old with earned income, a
bank account, and medical expenses would be recorded under Element 150
(Household Composition), not Elements 211 (Bank Accounts or Cash on Hand), 311
(Wages and Salaries), and 365 (Medical Deduction).
Variances should not be coded under this Element for persons with characteristics
that are specifically addressed under other 100 Series Elements (Student Status
through Social Security Number). For example: the discovery of an eligible noncitizen in the household who was improperly excluded would be coded under
Element 130 (Citizenship and Non-Citizen Status), not under Element 150
(Household Composition).
Nature codes:
7 - Ineligible person(s) included
12 - Eligible person(s) with no income, resources, or deductible expenses
excluded
13 - Eligible person(s) with income excluded
14 - Eligible person(s) with resources excluded
15 - Eligible person(s) with deductible expenses excluded
16 - Newborn infant improperly excluded

Element 151 - Recipient Disqualification
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 160 – Employment & Training Programs
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 161 – Time-limited Participation
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

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Element 162 – Work Registration Requirements
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 163 – Voluntary Quit/Reduced Work Effort
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 164 – Workfare and Comparable Workfare
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 165 – Employment Status/Job Availability
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 166 – Acceptance of Employment
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

Element 170 – Social Security Number
Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

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RESOURCES - (200)
Liquid Resources
Element 211 – Bank Accounts or Cash on Hand
Nature codes:
24 - Resource should have been excluded
30 – Resource should have been included

Element 212 – Nonrecurring Lump-sum Payment
Nature codes:
24 - Resource should have been excluded
30 – Resource should have been included

Element 213 – Other Liquid Assets
Nature codes:
24 - Resource should have been excluded
30 – Resource should have been included

Non-Liquid Resources
Element 221 – Real Property
Nature codes:
24 - Resource should have been excluded
30 – Resource should have been included

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Element 222 – Vehicles
Nature codes:
24 - Resource should have been excluded
30 – Resource should have been included

Element 224 – Other Non-Liquid Resources
Nature codes:
24 - Resource should have been excluded
30 – Resource should have been included

Element 225 – Combined Resources
Nature codes:
20 - Incorrect resource limit applied
29 - Exceeds prescribed limit

INCOME (300)
Earned Income
Element 311 – Wages and Salaries
Nature codes:
32 - Failed to consider or incorrectly considered income of an ineligible
member
35 – Unreported source of income (do not use for change in employment status)
36 – Rounding used/not used or incorrectly applied
38 – More income received from this source than budgeted
39 - Employment status changed from unemployed to employed
40 - Employment status changed from employed to unemployed
41 - Change only in amount of earnings
42 - Conversion to monthly amount not used or incorrectly applied
43 - Averaging not used or incorrectly applied
44 – Less income received from this source than budgeted
46 - Failed to consider/anticipate month with extra pay date
123 – Income incorrectly prorated

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Element 312 – Self-Employment
Nature codes:
32 - Failed to consider or incorrectly considered income of an ineligible
member
35 – Unreported source of income (do not use for change in employment status)
36 - Rounding used/not used or incorrectly applied
38 – More income received from this source than budgeted
39 - Employment status changed from unemployed to employed
40 - Employment status changed from employed to unemployed
41 - Change only in amount of earnings
42 - Conversion to monthly amount not used or incorrectly applied
43 - Averaging not used or incorrectly applied
44 – Less income received from this source than budgeted
45 - Cost of doing business not used or incorrectly applied

Element 314 – Other Earned Income
Nature codes:
32 - Failed to consider or incorrectly considered income of an ineligible
member
35 – Unreported source of income (do not use for change in employment status)
36 - Rounding used/not used or incorrectly applied
38 – More income received from this source than budgeted
39 - Employment status changed from unemployed to employed
40 - Employment status changed from employed to unemployed
41 - Change only in amount of earnings
42 - Conversion to monthly amount not used or incorrectly applied
43 - Averaging not used or incorrectly applied
44 – Less income received from this source than budgeted
45 - Cost of doing business not used or incorrectly applied

Deductions
Element 321 – Earned Income Deductions
Nature codes:
52 - Deduction that should have been included was not
53 - Deduction included that should not have been

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Element 323 – Dependent Care Deduction
Nature codes:
52 - Deduction that should have been included was not
53 - Deduction included that should not have been

Unearned Income
Element 331 – RSDI Benefits
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

Element 332 – Veterans Benefits
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

Element 333 – SSI and/or State SSI Supplement
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

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Element 334 – Unemployment Compensation
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

Element 335 – Worker’s Compensation
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

Element 336 – Other Government Benefits
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

Element 342 – Contributions
Note: Errors in Child Support Payments should not be recorded in this Element.
See Element 350 (Child Support Payments Received from Absent Parent).
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
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44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

Element 343 – Deemed Income
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

Element 344 – TANF, PA, or GA
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
120 - Variance/errors resulting from noncompliance with this means-tested
public assistance program
124 - Variance resulting from use of automatic Federal information exchange
system

Element 345 – Educational Grants/Scholarships/Loans
Nature codes:
35 - Unknown source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange
system

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Element 346 – Other Unearned Income
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
120 - Variance/errors resulting from noncompliance with this means-tested
public assistance program
124 - Variance resulting from use of automatic Federal information exchange
system

Element 350 – Child Support Payments Received from Absent
Parent
Nature codes:
35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted
111 - Child support payment(s) not considered or incorrectly applied for initial
month(s)of eligibility
112 - Retained child support payment(s) not considered or incorrectly applied
124 - Variance resulting from use of automatic Federal information exchange
system
127 - Pass through not considered or incorrectly applied

Element 361 – Standard Deduction
Nature codes:
52 - Deduction that should have been included was not
53 - Deduction included that should not have been
65 – Incorrect standard used resulting from a change in household size

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Element 363 - Shelter Deduction
Nature codes:
52 - Deduction that should have been included was not
53 – Deduction included that should not have been
64 - Incorrect amount used resulting from a change in residence
123 - Incorrectly prorated

Element 364 - Standard Utility Allowance
Nature codes:
52 – Deduction that should have been included was not
53 - Deduction included that should not have been
54 - Incorrect standard used (Not as a result of a change in household size or
move)
64 - Incorrect amount used resulting from a change in residence
123 - Incorrectly prorated

Element 365 - Medical Deductions
Nature codes:
52 - Deduction that should have been included was not
53 - Deduction included that should not have been

Element 366 - Child Support Payment Deduction
Nature codes:
52 - Deduction that should have been included was not
53 - Deduction included that should not have been

Element 371 - Combined Gross Income
Nature codes:
28 - Incorrect income limit applied
29 - Exceeds prescribed limit

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Element 372 - Combined Net Income
Nature codes:
28 - Incorrect income limit applied
29 - Exceeds prescribed limit

OTHER - (500 and 800)
Element 520 - Arithmetic Computation
Nature codes:
75 - Benefit/allotment/eligibility incorrectly computed
79 – Incorrect use of allotment tables
80 - Improper proration of initial month’s benefits

Element 530 – Transitional Benefits
75 - Benefit/allotment/eligibility incorrectly computed
77 - Household not entitled to transitional benefits
99 - Other

Element 560 - Reporting Systems
Note: This element should be used to record errors resulting from the household
being certified under an incorrect reporting system given the household’s
characteristics and the State agency’s chosen options. Possible Reporting Systems
include: Monthly Reporting, Quarterly Reporting, Semi-Annual Limited Reporting,
Change Reporting, Status Reporting, 5 Hour Reporting and no reporting
(transitional benefits).
Nature codes:
301 - Household improperly participating under retrospective budgeting
302 - Household improperly participating under prospective budgeting
303 - Household improperly participating under monthly reporting
304 - Household improperly participating under quarterly reporting
305 - Household improperly participating under semi-annual reporting
306 - Household improperly participating under change reporting

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307 - Household improperly participating under status reporting
308 - Household improperly participating under 5 hour reporting
309 - Household improperly participating in transitional benefits

Element 810 - Food Stamp Simplification Project
Nature codes:
98 - Transcription or computation errors
99 - Other

Element 820 - Demonstration Projects
Nature codes:
98 - Transcription or computation errors
99 – Other

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14. Cause - Enter one of the following codes to indicate the primary cause for
each variance identified.
1 - Information not reported. (Client failed to report information or changes
that are required to be reported. Use this code only if the State could not
know this information from another source or could not have anticipated
the change.)
2 - Incomplete or incorrect information provided. (Client provided information
that is incorrect or incomplete and the agency was not required to verify.)
3 – Information withheld by client. (Case being referred for IPV investigation.)
4 - Incorrect information provided by client. (Case being referred for IPV
investigation.)
7 - Information reported by a collateral contact inaccurate. (The agency acted
upon information provided by a collateral contact, which was verified by
QC to be inaccurate, i.e. the client’s employer reported incorrect salary
information.)
8 – Acted on incorrect Federal computer match information that was not
required to be verified. (This variance is excluded from the error
determination but must be recorded.)
10 - Policy incorrectly applied. (The agency used the wrong policy/incorrectly
applied policy when determining eligibility or processing change
information.)
12 - Reported information disregarded or not applied. (The agency failed to
take action on information reported by the client or information that
became known through some other source, such as non-federal match
information.)
14 - Agency failed to follow up on inconsistent or incomplete information.
(Information provided by the household or collateral source was
inconsistent with other information in the case record or incomplete but
the agency failed to request verification.)
15 - Agency failed to follow up on impending changes. (The agency failed to
take follow up action on a change that was anticipated, i.e.
unemployment ending within the certification period, pregnancy, etc.)

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16 - Agency failed to verify required information. (The agency failed to use
third party information or documentation to establish the accuracy of
statements on the application or change report form which are required to
be verified. If the agency is not required to verify reported information
use code 2.)
17 - Computer programming error. (The agency eligibility system caused the
error due to a programming related problem, i.e. an incorrect amount for
standard deduction was programmed into the system, the agency
authorized the use of workarounds to the computer system that resulted
in an error, etc.)
18 – Data entry and/or coding error. (The agency made a data entry error
when keying into the State/local agency eligibility system, includes
selection of incorrect codes.)
19 – Mass Change. (The error was due to a problem with a computer generated
mass change, i.e. mass change was run late or incorrectly updated the
case.)
20 - Arithmetic computation. (The agency made an error in computation or
transcription, which was not related to computer programming or data
entry.)
21 - Computer user error. (The EW failed to use computer system properly or
used an unauthorized process to work around the system.)
99 - Other. (Variance caused by the agency, which does not fall under any of
the specific causes listed above.)

15. Error Finding – (Optional). This item provides a means for reviewers to
identify the impact of individual variances. If only one variance is recorded for
an error case, the error finding code for this item and item 8, finding, should
be the same. Enter the appropriate code for each variance:
2 - Overissuance
3 - Underissuance
4 – Ineligible

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16. Error Amount - (Optional) Compute and enter the dollar amount of each
separate variance. If one variance is coded, then the amount in this item
should be the same as the error amount in item 10. If more than one variance
is coded, the agency may use the optional guidance provided in Chapter 12 or
use State developed procedures for assigning dollar amounts. Some agencies
find this calculation helpful as an aid in prioritizing error causes for corrective
actions.

17. Discovery - Enter one of the following codes to indicate how the variance was
discovered:
1 - Variance clearly identified from case record: documentation is not from an
automated match
2 - Variance clearly identified from case record: documentation is from an
automated match
3 - Variance discovered from recipient interview
4 - Employer (present or former)
5 - Financial institution, insurance company, or other business
6 - Landlord
7 - Government agency or public records, not automated match
8 - Government agency or public records, automated match
9 – Other

18. Verified - Enter one of the following codes to indicate how the variance was
verified:
1 - From case record: verification is not from an automated match
2 - From case record: verification is from an automated match
3 - From information provided by recipient
4 - Employer (present or former)
5 - Financial institution, insurance company, or other business
6 - Landlord
7 - Government agency or public records, not automated match
8 - Government agency or public records, automated match (may not apply to
tax information)
9 - Other

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19. Occurrence - Complete the following for each variance:
a.

Date - Enter the date (month and year) the variance occurred.

b.

Time Period - Enter the appropriate code to indicate the time period
during which the variance occurred.
1 - Before most recent action by agency (The most recent action would
be either a certification or a recertification.)
2 - At time of most recent action by agency
3 - After the most recent action by agency
9 - Time of occurrence cannot be determined

SECTION 3 - HOUSEHOLD CHARACTERISTICS
This section collects information about the household’s processing and specifics about
resources, income, and deductions that were the basis of their food stamp benefits.
Some specific items come from the case record (Items 20-24, and 26-27). These items
are: most recent action, type of action, length of certification period, allotment
adjustment, amount of adjustment, receipt of expedited service, and authorized
representative.
For all other items use information from the final QC determination.

20.

Most Recent Certification Action - Enter the effective date (month, day
and year) of the most recent certification or recertification action prior to or
concurrent with the review date. This date cannot be prior to the start of the
most recent certification period and should be in the case record.

21.

Type of Action – Based on information in the case record, indicate the type
of action by entering one of the following codes:
1 - Certification
2 - Recertification
Certification means the first time a case has been certified or a certification
action following a break in participation.

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Recertification means the initial certification period has expired and the
agency has (a) completed a reexamination of all factors of eligibility subject to
change following a period of time during which the recipient has been
determined eligible and (b) made a decision to continue eligibility.

22. Length of Certification Period - Enter the number of months the household
was certified to participate during the current certification or recertification.
For households that are participating in months for which
they have not been certified enter the code 98. This information should be
found in the case record.

23. Allotment Adjustment – This item records whether there was any
adjustment from the standard amount for the household size and income level
of the household. Proration is providing less than a full month’s allotment due
to the date of application or receipt of verification. Other adjustments include
claims recoupment, sanctions, and adjustments for failure to comply with other
means tested programs. Supplements included in the allotment are not
considered as allotment adjustments for this item.
Enter the code that indicates whether or not the allotment was adjusted or
prorated. If more than one adjustment was made, enter the code for the
adjustment with the greatest impact on the food stamp allotment.
Supplements included in the allotment are not considered as allotment
adjustments for this item.
1 - No adjustment
2 - Prorated benefit
3 - Other adjustment

24. Amount of Allotment Adjustment - Enter the amount of the allotment
adjustment from the record. If more than one adjustment was applied, enter
the total amount of the difference between the allotment for the household
size and income of the household and the amount the household actually
received. If item 23 is coded 1, no adjustment, leave this item blank. Enter 9
if the amount of adjustment is unknown.

25. Number of Household Members - Enter the number of person(s)
determined to be a part of the food stamp household and eligible to receive
benefits based on the final QC determination. Include persons who should have
been in the household but were not in the State’s original determination. Do
not include persons whose income/resources are considered but are not
receiving food stamps or food stamp household members who have been
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disqualified from the program. If the household was ineligible for benefits,
enter zero.

26.

Receipt of Expedited Service – Using information from the case record,
enter the appropriate code for the household’s entitlement to expedited
service at the most recent certification in effect at the time of the sample
month:
1 - Entitled to expedited service and received benefits within the Federal
timeframe.
2 - Entitled to expedited service but did not receive benefits within the Federal
timeframe.
3 - Not entitled to expedited service.

27.

Authorized Representative Used at Application - Enter the
appropriate code using information from the case record. An authorized
representative is a responsible adult designated by the household, in writing, to
apply for benefits on behalf of the household. Did an authorized
representative make application for the household?
1 - Yes
2 - No

28. Categorical Eligibility Status – Was the household categorically eligible for
benefits based on the final QC determination?
1 –Yes
2 – No

29. Reporting Requirement - Select the code that describes the reporting
system used to certify the household. If the household was certified under sixmonth reporting enter code “6”, simplified reporting (also called six month
reporting or semiannual reporting), even if QC determined that the appropriate
reporting system should have been something else.
1 - $25 change reporting
2 - $80 change in earned income
3 - $100 change in earned income
4 - Status reporting
5 - 5-hour change in hours worked and expected to continue over a month
6 - Simplified reporting (exceeding 130% of income poverty guidelines)
7 - Quarterly reporting

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8 - Monthly reporting
9 - Transitional benefits (no reporting requirement)
10 – Other

Resources:
30.

Liquid Assets – Enter the dollar value of liquid assets such as cash on hand,
checking and savings accounts, money market accounts, stocks, bonds, income
tax refunds using information from the final QC determination. For amounts
greater than $99,998 enter the code 99998. When there is an indication that a
resource type was present but that amount is unknown, enter the code 99999.
If an approximate amount is known, enter that amount.

31. Real Property (Excluding Home) - Enter the dollar value of land and
buildings owned, excluding the primary residence using information from the
final QC determination. For amounts greater than $99,998 enter the code
99998. When there is an indication that a resource type was present but that
amount is unknown, enter the code 99999. If an approximate amount is known,
enter that amount.

32(a). Vehicle - Code information on up to two vehicles in items (a) and (b). Use
information from the final QC determination. Vehicles should be entered in
descending order based on the fair market value.
1 - No vehicles
2 - Vehicle exempt because used for producing income, as a home, to transport
a physically disabled member, for long distance travel (other than
commuting), or to carry fuel or water.
3 - Vehicle exempt because inaccessible resource (equity value is $1,500 or
less)
4 – Vehicle exempt due to categorical eligibility
5 - Vehicle excluded under State TANF standard (vehicle of non-categorically
eligible household members only)
6 - Vehicle is registered and is attributable to an adult household member or is
used by a person under 18 for employment or education (subject to fair
market value only)
7 - Vehicle not registered (equity test only)
8 - Vehicle is not excluded and is not included in code 6 (subject to fair market
value or equity test, whichever is greater)

32(b). Status 2nd Vehicle – Use the codes 2 through 8 from 32(a).

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33. Countable Vehicle Assets – Record that portion of a vehicle’s value
counted toward the household’s resource limit using information from the final
QC determination.

34. Other Non-liquid Assets – Enter the dollar value of non-liquid assets such as
boats and trailers using information from the final QC determination. For
amounts greater than $99,998 enter the code 99998. When there is an
indication that a resource type was present but that amount is unknown, enter
the code 99999. If an approximate amount is known, enter that amount.

Income:
35.

Gross Countable Income - Enter the countable gross monthly income of
the Food Stamp household before applying any deductions to the income from
the final QC determination. Enter all countable income. Include prorated
amounts from ineligible household members.

36.

Net Countable Income- Enter the countable net monthly income from the
final QC determination used to compute the amount of the Food Stamp
allotment for the sample month after application of all appropriate deductions.

Deductions:
37.

Earned Income - Enter the amount of the earned income deduction that the
household was eligible to receive based on the final QC determination.

38.

Medical - Enter the amount of the allowable medical expenses for elderly and
disabled household members based on the final QC determination.
Do not record the value of the allowable medical deduction ($35). Enter those
medical expenses in excess of $35 per month.
For example, if a household was billed $100 for medical expenses, enter $65
($100 minus the medical deduction of $35).

39. Dependent Care - Enter the total dependent care deduction to which the
household was entitled based on the final QC determination.

40. Child Support - Enter the dollar value of the child support payment
deduction from the final QC determination.
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41. Shelter - Enter the dollar value of the shelter deduction from the final QC
determination.

42. Homeless - Select the code that applies to this household based on the final
QC determination.
1 - Not homeless
2 - Homeless, not receiving homeless shelter allowance
3 - Homeless, receiving homeless shelter allowance

Additional Information on Shelter Costs:
43. Rent/Mortgage - Enter the amount the household was billed for
rent/mortgage from the final QC determination. Include taxes, insurance,
condo fees and homeowner association fees.

44. Use of SUA – This entry has two boxes that are used to collect different
information about the SUA. Do not complete 44(b) if 44(a) is coded 1.

a. Usage - Enter the code which describes usage and entitlement to the SUA
based on the final QC determination:
1 - No utilities and no LIHEAA
2 - Uses actual expenses
3 - Uses higher standard based on LIHEAA
4 - Uses higher standard and does not receive LIHEAA
5 - Uses lower standard
6 – Uses phone only standard
7 – Uses individual standards
9 - Other
LIHEAA is the Low Income Home Energy Assistance Act, your State program
may have another name such as Home Energy Assistance Program (HEAP)
Higher Standard is an SUA based upon receipt of heating or cooling and
includes all utilities
Lower Standard is an SUA based upon all utilities but is for households who
do not incur heating or cooling or receive LIHEAA.

b. Proration - Select the code that identifies whether the SUA amount was
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prorated (e.g. prorated among non-household members of the residence).
1 - Not prorated
2 – Prorated

45. Utilities (SUA or Actual) - This item should be completed for all cases. For
households using actual utility expenses, enter the actual amount that was
billed for all utilities (gas, water, phone, electric, etc.) based on the final QC
determination. For households using an SUA, enter the amount of the SUA that
was used, based on the final QC determination. Enter $0 if there were no
utility expenses.

SECTION 4 – INFORMATION ON EACH HOUSEHOLD MEMBER
Complete the following section, using information from the final QC determination,
for eligible food stamp households. Enter information on each household member,
including individuals whose income and resources were considered in establishing food
stamp benefit level. If the number of household members exceeds the number of
lines available, attach an additional page to allow for coding detailed person-level
information on all food stamp household members. You may currently enter
information on up to 16 individuals on the automated system, but you may record
information on all household members using the paper form. If the entire household
is ineligible do not enter any information in this section.
For disqualified or ineligible food stamp household members, items 46, 47, 48, and
58, if applicable, (person number, food stamp program participation, relationship to
head of household, and dependent care costs) of this section must be completed.
Information on income for these members must also be recorded in Section 5. For
disqualified or ineligible members, the rest of the information in this section should
be completed based on information known through observation or available in the
case record.
NOTE: Do not enter zeros in items 48, 50-52, and 54-58 (Relationship to Head of
Household, Sex, Race, Citizenship Status, Employment Status, Work Registration,
Employment and Training Program Status, ABAWD Status, and Dependent Care Cost).

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46. Person Number - Assign and enter a number for each food stamp
household member (1, 2, etc.). This will include ineligible food stamp
household members whose resources and income are considered in the
eligibility determination. Use this assigned number to identify
household members with income in Section 5. Code the head of the
household as person 1.

47. Food Stamp Program Participation – For each person indicate
his/her eligibility or ineligibility for participation in the FSP (i.e., either
eligible for participation and entitled to benefits or a reason for
ineligibility. For ineligible non-citizens, whether they participate in a
State funded FSP).
1 – Eligible member of Food Stamp case under review and entitled to
receive benefits
2 - Reserved
3 - Reserved
4 - Member is an ineligible non-citizen and is not participating in a State
funded FSP
5 - Member not paying/cooperating with Child Support agency
6 - Member is an ineligible striker
7 - Member is an ineligible student
8 - Member is disqualified for program violation
9 - Member is ineligible to participate due to disqualification for failure
to meet work requirements (work registration, E&T, acceptance of
employment, employment status/job availability, voluntary
quit/reducing work effort, workfare/comparable and workfare).
10 - ABAWD time limit exhausted and the ABAWD is ineligible to
participate due to failure to meet ABAWD work requirements, to
work at least 20 hours per week, to participate at least 20 hours per
week in qualifying educational training activities or to participate in
workfare.
11 - Fleeing felon or parole and probation violator
12 – Reserved
13 - Convicted drug felon
14 - Social Security Number disqualified
15 - SSI recipient in California.
16 - Prisoner in detention center
17 - Foster care
18 - Member is an ineligible non-citizen and is participating in a Statefunded Food Stamp Program.
99 - Unknown

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48. Relationship to Head of Household - Enter the code that shows the
relationship (including by marriage) of the person indicated in item 46
(person number) to the head of the household, as defined by the Food
Stamp Program from final QC determination.
12345-

Head of household
Spouse
Parent
Daughter, stepdaughter, son, stepson
Other related person (brother, sister, niece, nephew, grandchild,
great-grandchild, cousin)
6 – Foster Child
7 - Unrelated person

49. Age - Enter the age (in years) from the final QC determination, of each
household member. For children less than 1 year old, enter 0. For
persons 98 and older enter 98. If exact age is unknown, enter the best
available information.

50. Sex - Enter the appropriate code:
1 - Male
2 – Female

51. Race - Enter the race of each person living in the household.
*
*
*
*
*
*
*
*
*
*
*
*
*
*

This is to collect racial and ethnic data as required by the changes brought
about by the May 18, 2006 regulation Food Stamp Program: Civil Rights Data
Collection and to identify how to collect the information until the entire
caseload has been converted to the new requirement. The change to the new
format may be done voluntarily at this time but is required for all new
applications and recertifications effective April 1, 2007. Under this scenario
QC reviewers will be recording the racial/ethnic data in the new format as
soon as available and will be collecting the old format from now through April
2009.
New format: Use codes 1 through 22 to record information if it has been
collected in the new format.
Old format: Use codes 30 through 34 and 99 if the data is in the old format.
We expect the information will continue to be in the old format for most cases

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until there are new applications and recertification after April 1, 2007. Due to
the way that recertifications are scheduled, cases will continue to have the old
format until their certification periods expire in the year following for most
cases and 2 years for those elderly cases with 24 month certification periods.
This will mean that all cases will be in the new format on April 1, 2009.

*
*
*
*

Under the rules for the new format, applicants are asked to voluntarily fill out
ethnicity and race on their applications. Eligibility workers identify
information for the applicant when they have not voluntarily filled out the
information. QC reviewers are to collect only the information that has been
recorded on the application.

*
*
*
*
*

New Format

*

Information Not Available

*

1 – The application was not found during the QC review therefore
racial/ethnic data is not available.
2 – Not recorded on the application for this individual.
Not Hispanic or Latino
3–
45–
6–
7–

*

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White

Multiple races reported

*
*
*
*
*
*

8 – (American Indian or Alaska Native) and White
9 – Asian and White
10 – (Black or African American) and White
11 – (American Indian or Alaska Native) and (Black or African American)
12 – Respondent reported more than one race and does not fit into the
above categories (code 8 through 11)

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*
*
*

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*
*
*
*
*
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FNS HANDBOOK 310
*

Hispanic or Latino

*
*
*
*
*

13 –
14 –
15 –
16 –
17 –

(Hispanic
(Hispanic
(Hispanic
(Hispanic
(Hispanic

or
or
or
or
or

Latino) and (American Indian or Alaska Native)
Latino) and Asian
Latino) and (Black or African American)
Latino) and (Native Hawaiian or Other Pacific Islander)
Latino) and White

*

Multiple races reported

*
*
*
**
*
*
*
*

18 – (Hispanic or Latino) and (American Indian or Alaska Native) and
White
19 – (Hispanic or Latino) and Asian and White
20 – (Hispanic or Latino) and (Black or African American) and White
21 – (Hispanic or Latino) and (American Indian or Alaska Native) and
(Black or African American)
22 – (Hispanic or Latino) and Respondent reported more than one race
and does not fit into the above categories (code 18 through 21)

*

Old Format

*
*
*
*
*
*
*

These codes are for the recording of race based upon the older data collection
requirements for those cases where the new format has not yet been
collected. Remember racial and ethnic data must be collected in the new
format for all new applications and recertifications above beginning April 1,
2007. Under the old data collection reviewers identify the racial/ethnic
category of the members of the household as they can by either asking the
person being interviewed or through personal observation.

*

Racial/Ethnic Data Not Collected in the New Format

*
*
*
*
*
*

30 31 32 33 34 99 –

White, not of Hispanic origin
Black, not of Hispanic origin
Hispanic
Asian or Pacific Islander (Oriental)
American Indian or Alaskan Native
Unknown

52. Citizenship Status - Enter the appropriate code.
1 - U.S. born citizen
2 - Naturalized Citizen

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3 - Legal permanent resident with 40 quarters, military service, five
years legal United States residency, disability, or under 18 years of
age.
4 – Reserved
5 – Person admitted as refugee, granted asylum or given a stay of
deportation.
6 - Other eligible non-citizen
7 - Non-citizen legally in US who does not meet one of the above codes
and who is not receiving food stamps but whose income and
resources must be considered in determining benefits
8 – Other ineligible legal non-citizen (e.g. visitor, tourist, student,
diplomat)
9 - Undocumented non-citizen
10 - Non-citizen, status unknown
99 – Unknown

53. Educational Level - Enter highest educational level completed for
each member of the household from the final QC determination:
0 - None
1 - Grade 1
2 - Grade 2
3 - Grade 3
4 - Grade 4
5 - Grade 5
6 - Grade 6
7 - Grade 7
8 - Grade 8
9 - Grade 9
10 - Grade 10
11 - Grade 11
12 - High school diploma or GED*
13 - Post secondary education (e.g. technical education or some college)
14 - College graduate or post-graduate degree
99 - Unknown
* If member attended grade 12 but did not graduate, use code 11.

54. Employment - Enter information on the current employment status of
all persons based on the final QC determination.

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First box: Status
1–
2–
3–
4–
5–
6–
78–

Not in labor force and not looking for work
Unemployed and looking for work
Active duty military
Migrant farm laborer
Non-migrant farm laborer
Self-employed, farming
Self-employed, non-farming
Employed by other

Second box: Hours Worked
1–
2–
3–
4–
5–

Not employed
1-19 hours per week
20-29 hours per week
30-39 hours per week
40+ hours per week

55. Food Stamp Program Work Registration - Enter information on
the current work registration status of all persons as known by the State
agency based on the final QC determination:
*
*

12–
345-

Federal exemption for disability
Federal exemption for a reason other than disability
Work registrant, not employment and training (E&T) participant
Work registrant, voluntary E&T participant
Work registrant, mandatory E&T participant

56. Food Stamp Program (FSP) Employment and Training (E&T)
Program Status - Enter information on the current E&T program status
of all household members as known by the State agency based on the
final QC determination:
0–
1–
2–
3–
4–
5–
6–

Not participating in E&T
Participating in non-FSP E&T (such as TANF)
FSP Job search or job search training
FSP E&T workfare or work experience
FSP E&T Work supplementation
FSP E&T education leading to HS diploma or GED
FSP E&T post secondary education leading to degree or certificate

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7 – FSP E&T remedial education (including adult education and English
lessons not leading to a degree)
8 – FSP E&T vocational training
9 - Other

57. ABAWD Status - A household member must be age 18 through 49 to be
an Able Bodied Adult Without Dependents (ABAWD). Enter one of the
following codes from the final QC determination:
123456-

Not an ABAWD
ABAWD in a waived area
Exempt based on 15 percent option
ABAWD meeting work requirements
ABAWD in 1st 3 months
ABAWD in 2nd 3 months

58. Dependent Care Cost - For each child/adult with associated
dependent care expenses enter the amount of the expense that the
household is responsible for paying using information from the final QC
determination. If the cost for more than one child/adult is combined,
divide the cost evenly amongst each child/adult receiving care.

SECTION 5 – INCOME IDENTIFIED BY HOUSEHOLD MEMBER
This section collects detailed information on known income sources, by type
and amount, based on the final QC determination. Information can be
collected on up to four sources of income for up to ten household members. If
income exists but is not attached to any specific member, assign the income to
the payee. Enter all income amounts rounded to the nearest dollar.

59. Person Number – Enter the person number from Section 4 for each
food stamp household member with income based on information from
the final QC determination. (This number is assigned in Section 4, item
46).

Source 1
60. Income Type - (This instruction applies to items 60, 62, 64, and 66).
Based on the final QC determination, identify the type of countable
income as listed below for each type of income received by a food
stamp household member.

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Earned Income (Not Subsidized)
11 - Wages and salaries
12 - Self-employment
14 - Other earned income
Subsidized Earned Income
16 - Wage supplementation - enter earnings that are above cash
assistance and/or food stamp amount
Unearned Income
15 - Energy Assistance income
31 - RSDI benefits
32 - Veterans benefits
33 - SSI
34 - Unemployment Compensation
35 - Workmen’s Compensation
36 - Other government benefits
37 – Foster care income
42 - Contribution
43 - Deemed income
44 - State general assistance or other State-funded welfare (don’t
include TANF here)
45 - Educational grants/scholarships/loans
46 – Other
47 - TANF
48 - State only diversion payment
49 – Interest income
50 - Court ordered child support payments received from absent parent
or responsible person
99 - Unknown

61. Amount - (This instruction applies to Items 61, 63, 65, and 67.) Enter
the gross amount of countable income received by the food stamp
household member for the month from the final QC determination.

Source 2
62. Income Type - Second type of income. See item 60.
63. Amount - Second amount of income. See item 61.

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Source 3
64. Income Type - Third type of income. See item 60.
65. Amount - Third amount of income. See item 61.
Source 4
66. Income Type - Fourth type of income. See item 60.
67.

Amount - Fourth amount of income. See item 61.
SECTION 6 - RESERVED CODING

68. Timeliness of Application Processing (Expedited and 30 Day
Requirement - This information is being collected for possible bonus
payments. We want to delineate if there was timeliness of application
processing for cases when a new application was filled in the current
Federal Fiscal Year.
Timeliness of application processing is measured for cases that filed an
application in the current Fiscal Year. If there is more than one
application in the current Fiscal Year, measure timeliness for the most
recent application for or prior to the sample month.
We are measuring the timeliness of application processing according to
Federal processing standards. A household entitled to expedited service
must be provided the opportunity to participate within 7 days.
Households not entitled to expedited service must be provided the
opportunity to participate by the 30th day following the date of
application. A case that meets the applicable Federal processing
standard is coded 1 – timely. A case that fails to meet the applicable
Federal processing standard is coded 2 – not timely.
If a new application was not filed in the review year, the case will not
be used in determining the bonus payment. The case should be coded 3
– Other. Also, use Code 3, for cases that have been properly pended for
incomplete verification. Improperly pended cases should be coded 2 –
not timely.

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If after a thorough review of case circumstances and records there is no
documentation, application or other information to determine
timeliness, the case should be coded 3. For cases with this problem,
every effort should be made to determine the timeliness of the case
before deciding to use the Other code.
Please indicate the appropriate code:
1 – Timely
2 – Not timely
3 - Other

*

69. – 76. – Reserved

SECTION 7 – OPTIONAL FOR STATE USE
There are 4 lines of spaces available to the State to code additional
information.

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