Form FNS-245 Quality Control - Food Stamp Negative Case Action Review

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FORM APPROVED OMB NO. 0584-0034
Expiration Date: XX/XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

QUALITY CONTROL - SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
NEGATIVE CASE ACTION REVIEW SCHEDULE
I. CASE MANAGEMENT INFORMATION (Not to be Transmitted)
1. CASE NAME (Last, First, MI)

2. TELEPHONE NUMBER

3. MAILING ADDRESS

4. ACTUAL ADDRESS/DIRECTIONS TO LOCATE

5. DATE ASSIGNED
MONTH

6. DATE COMPLETED/DISPOSED OF

DAY

YEAR

MONTH

DAY

7. DATE CLEARED

YEAR

MONTH

Reviewer

DAY

YEAR

Supervisor

II. IDENTIFYING INFORMATION
A. REVIEW NUMBER

C. STATE AND LOCAL AGENCY
CODE

B. CASE NUMBER

E. STRATUM

F. NOTICE DATE
MONTH

G. ACTION DATE

DAY

YEAR

MONTH

DAY

D. SAMPLE MONTH AND YEAR

H. ACTION TYPE

I. CASE CLASSIFICATION

YEAR

III. ANALYSIS OF REVIEW ACTIVITY
J. NOTICE REQUIREMENTS

K. RECORDED REASON FOR ACTION

L. FINDING

M. HOUSEHOLD NOTICE

N. DISPOSITION OF REVIEW

(a) Notice Specific, Clear,
Understandable

(b) Reason HH

IV. DESCRIPTION OF VARIANCES
O. ELEMENT CODE

1.

P. NATURE CODE

2.

3.

1.

2.

3.

RESERVED CODING

Q. ACCURACY
RECORDED REASON

R. ACCURACY HOUSEHOLD
REASON

S. COLLATERAL/HOUSEHOLD T. ACTION INITIATED U. NSTR RESERVED FOR FUTURE USE
REASON
BY
CONTACT

OPTIONAL (STATE SYSTEMS ONLY)

V. EXPLANATION OF REVIEW FINDINGS

FORM FNS-245 (01/12) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 9.1 Version

EXPLANATION OF REVIEW FINDINGS CONTINUED:

PRIVACY ACT STATEMENT

OMB PAPERWORK COLLECTION STATEMENT

This report is required under provisions of 7 CFR
275.14 (The Supplemental Nutrition Assistance
Program). This information is needed for the
review of State performance in determining the
eligibility of applicants and recipients. The
information is used to determine State compliance,
and failure to report may result in a finding of noncompliance.

According to the Paperwork Reduction Act of 1995, no
persons are required to respond to a collection of
information unless it displays a valid OMB control
number. The valid OMB control number for this
information collection is 0584-0034. The time
required to complete this information collection is
estimated to average 2.9406 hours per response,
including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information.

APPENDIX D
INSTRUCTIONS FOR COMPLETING FORM FNS-245,
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
QUALITY CONTROL NEGATIVE CASE ACTION REVIEW SCHEDULE
GENERAL INSTRUCTIONS
The Negative Case Action Review Schedule was developed to serve as the data entry and review form for negative case action reviews. It is to be used
as both a worksheet and the review schedule. The schedule consists of five sections as follows:
I
II
III
IV
V

-

Case Management Information
Identifying Information
Analysis of Review Activity
Description of Variances
Explanation of Review Findings
SECTION I - CASE MANAGEMENT INFORMATION

This section provides case management information and household identity.
1.

Case Name - Enter the name of the applicant or recipient whose household's participation was denied, terminated or suspended.

2.

Telephone Number - Enter the telephone number of the household.

3.

Mailing Address - Enter the mailing address of the household.

4.

Actual Address/Directions to Locate - Enter the actual address at which the household resides, if different from the mailing address.

5.

Date Assigned - Enter the month, day, and year (MM DD YYYY) the case was assigned to the QC reviewer.

6.

Date Complete/Disposed of - Enter the month, day, and year (MM DD YYYY) the review was finalized; the reviewer's name/ID entry
indicates who did the review.

7.

Date Cleared - Enter the month, day, and year (MM DD YYYY) the supervisor cleared the review; the supervisor's name/ID entry indicates
completeness and approval of the review.
SECTION II - IDENTIFYING INFORMATION

This section provides identifying information related to the negative case action under review. For all cases, fill in items A through I.
ITEM A.

Review Number - Enter the number assigned to the negative action under review.

ITEM B.

Case Number - Enter the case number assigned by the State agency.

ITEM C.

State and Local Agency Code:
• State Agency Code - In the first two blocks, enter your two-digit State code. These are the codes used by the National Institute
of Standards and Technology.
• Local Agency Code - In the last three blocks, enter the same three-digit code that the State agency uses to code local agencies
for the QC review of active cases.

ITEM D.

Sample Month and Year - Enter the month and year for which the negative action was selected for review. The sample month for a
negative action is based upon how the case was selected for review. State agencies must identify for the reviewer how cases are
sampled so that the appropriate sample month and year are entered. Each State agency has an FNS approved sample plan.

ITEM E.

Stratum - Enter the two-digit stratum code. Stratum codes are assigned by the State agency when the sample is stratified. If stratum
codes are not used by the State, other information may be entered here as a State option.

ITEM F.

Notice Date - Enter the month, day and year (MM DD YYYY) the notice was sent for the negative action selected for review. If no
notice was sent, enter nines.

ITEM G.

Action Date - Enter the month, day and year (MM DD YYYY) the action was taken by the State agency for the negative action
selected for review.

ITEM H.

Action Type - Enter the action taken by the State agency using the appropriate code as follows:
1 - Denial of SNAP application
2 - Termination of SNAP benefits
3 - Suspension of SNAP benefits

ITEM I.

Case Classification - Enter the appropriate code as follows:
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).
SECTION III - ANALYSIS OF REVIEW ACTIVITY

This section provides information regarding the action taken and the analysis of the review of the action to deny a SNAP application, terminate SNAP
benefits or suspend SNAP participation. For completed cases, fill in items J through U. For cases that are not subject to review or incomplete fill out item
U only.
ITEM J.

Notice Requirements - Enter the appropriate code to indicate the reason for the action as reflected by the case record.
A - No requirement to issue a notice on this action.
B - Notice was accurate, timely, and contained all required information.
C - NOAA - Required notice not sent to the household. (This code should be used when no notice was sent or when the notice sent
went to the incorrect address.)
D - NOAA - Notice sent was not accurate/did not contain correct reason for action.
E - NOAA - Notice did not comply with applicable timeframes.
F - NOAA - Notice sent was not easily understandable.
G - NOAA - Notice sent did not contain the required information as defined by regulations.
H - NOAA - Notice sent did not contain correct reason for action and was not easily understandable.
I - NOAA - Notice did not contain correct reason for action and did not contain the required information as defined by
regulations.
J - NOAA - Notice sent did not contain correct reason for action and was not easily understandable and did not contain
the required information as defined by regulations.
K - NOMI - Required notice not sent to the household. (This code should be used when no notice was sent or when the
notice sent went to the incorrect address.)
L - NOMI - Notice sent to the household was not accurate.
M - NOMI - Notice did not comply with applicable timeframes.
N - NOMI - Notice was not easily understandable.
O - NOMI - Notice sent to the household did not contain the required information as defined by regulations.
P - NOMI - Notice sent to the household was not accurate and did not comply with applicable timeframes.
Q - NOMI - Notice sent to the household was not accurate and did not contain the information as defined by regulations.
R - NOMI - Notice did not contain required information as defined by regulations and did not comply with applicable
timeframes.
S - NOAA and NOMI - Notices to household were not sent/did not comply with timeframes.
T - Periodic Report - did not send the Interim Report.
U - Periodic Report - did not send the Interim Report within the appropriate timeframes.
V - Periodic Report - did not send Notice of Missing or Incomplete Report ten (10) days from the date the report should
have been submitted.
W - Request for Contact - did not send a request for contact which was clear and timely.

ITEM K.

Recorded Reason for Action - Enter the appropriate code to indicate the reason for the action as reflected by the case record.
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -

Resident of an institution not authorized by FNS
Outside of project area or State
Ineligible striker
Ineligible noncitizen
Ineligible student
Ineligible boarder
Missed scheduled interview(s)
Failed to provide verification
Refusal to cooperate
Refusal to supply SSN
Gross monthly income exceeds maximum allowance
Net Monthly income exceeds maximum allowance
Exceeds resource standard
Transfer of resources
Failure to comply, without good cause, with work registration/job search requirements
Voluntary quit
Failure to submit/complete report
Voluntary withdrawal after certification
Termination/denial due to TANF termination/denial
Intentional program violation
Termination/denial due to program disqualification
Termination/denial of household of able bodied adult(s) whose time limited period of SNAP eligibility has expired
Failure to comply, without good cause, with SNAP work requirements
Eligible for zero benefits
Failure to access EBT benefits
Loss of contact with household
Applicant/household deceased
Not eligible for separate household status

29 - Not eligible due to status as fleeing felon, parole violation, drug conviction etc.
30 - Reason for denial/termination/suspension not documented
31 - Household received benefits in another SNAP household for same time period
32 - Household received benefits in another state for the same time period
33 - Household received tribal commodities and is not eligible to receive SNAP benefits
99 - Other
ITEM L.

Finding - Final Analysis of the QC Review of the Negative Action - Enter the appropriate code:
01 - Valid Negative Action indicates that 1) the action taken was appropriate; and 2) the reason for the action was
correct; and 3) the household was notified on a clear, correct, complete notice with the correct reason for the action.
A valid determination requires that all three were correct.
02 - Invalid Negative Action indicates that either the action taken was not correct, or the reason for the action was not
correct or the notice given to the household was not correct or no notice was sent to the household when the notice
was required to have been sent. This could also indicate that any combination of the above were incorrect. An
invalid result requires that one of the items is incorrect. (Item M(a) = 2, Item M(a) = 3, Item Q = 2, Item R = 2; or
any combination of the four)

ITEM M.

Household Notice
(a) Notice Specific and Easily Understandable - Enter the appropriate code regarding the notice to the household.
The notice must be specific regarding the reason for the action; the explanation of the action must be clearly
understandable. (Example: If the notice contains a list of reasons and none are checked or identified as the
reason(s) for the action then code 2 would apply.) This measure is not to evaluate the validity of the reason; it is
to evaluate the clarity of the notice.
1 - Yes, the reason for the action stated on the notice is specific, the notice is clear and the notice is
easily understandable for the action.
2 - No, either the reason for the action stated on the notice is not specific, or the notice is not specific or the
notice is not easily understandable for the action; or both. A detailed and thorough explanation is required in
Section V, if code 2 is used.
3 - No notice was sent to household when notice was required.
4 - No notice was sent to household because a notice was not required.
(b) Reason to HH Enter the appropriate code to indicate the reason for the action as presented to the household.
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 -

Resident of an institution not authorized by FNS
Outside of project area or State
Ineligible striker
Ineligible noncitizen
Ineligible student
Ineligible boarder
Missed scheduled interview(s)
Failed to provide verification
Refusal to cooperate
Refusal to supply SSN
Gross monthly income exceeds maximum allowance
Net Monthly income exceeds maximum allowance
Exceeds resource standard
Transfer of resources
Failure to comply, without good cause, with work registration/job search requirements
Voluntary quit
Failure to submit/complete report
Voluntary withdrawal after certification
Termination/denial due to TANF termination/denial
Intentional program violation
Termination/denial due to program disqualification
Termination/denial of household of able bodied adult(s) whose time limited period of SNAP eligibility
has expired
23 - Failure to comply, without good cause, with SNAP work requirements
24 - Eligible for zero benefits
25 - Failure to access EBT benefits
26 - Loss of contact with household
27 - Applicant/household deceased
28 - Not eligible for separate household status
29 - Not eligible due to status as fleeing felon, parole violation, drug conviction etc.
30 - Reason for denial/termination/suspension not documented
31 - Household received benefits in another SNAP household for same time period
32 - Household received benefits in another state for the same time period
33 - Household received tribal commodities and is not eligible to receive SNAP benefits
99 - Other
00 - No notice sent to household

ITEM N.

Disposition of Review - Enter the appropriate code as follows:
1 - Review completed.
2 - Not Subject to Review/Listed in Error. Cases that are not subject to review are defined in Chapter 13 of the
FNS Handbook 310. If Code 2 is entered in this item, an entry in Reserved Coding section Item U must be
made with no further entries required on this schedule.
3 - Incomplete/Review Not Processed. Enter this code if the reviewer was unable to locate any form of the case
record or was unable to process the case as defined in Chapter 13 of the FNS Handbook 310. If Code 3 is
entered in this item, an entry in Reserved Coding section Item U must be made with no further entries required
on this schedule.
4 - Case deselected/correction for oversampling. If Code 4 is entered in this item, no further entries are required on
this schedule.
SECTION IV DESCRIPTION OF VARIANCES

This section provides for the description of variances identified in the review. Items O and P must be completed whenever the final determination for Item
L is invalid (code 2).
ITEM O.

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

ITEM P.

Nature Codes - Enter the appropriate three digit code for the nature of the identified variance(s). Possible nature codes for the
specific Element are listed below the Element code and title. The nature codes may be used in any element.
BASIC PROGRAM REQUIREMENTS - (100)

Element 111 - Student Status
Nature codes:
001 002 003 014 015 019 044 096 131 132 133 134 135 136 137 138 139 -

Eligible person(s) excluded
Ineligible person(s) included
Agency failed to follow up on inconsistent or incomplete information
Eligible student incorrect income
Eligible student incorrect student deductions
Eligible student was denied for failing to verify student status which was previously verified
Failed to consider or incorrectly considered Eligible Student status
Policy incorrectly applied
Eligible student excluded and met exemption - 17 and younger / 50 and older
Eligible student excluded and met exemption - Enrollment as part of Job
Eligible student excluded and met exemption - On-the-job training
Eligible student excluded and met exemption - Employment requirements met
Eligible student excluded and met exemption - Physically or mentally unfit
Eligible student excluded and met exemption - Receiving TANF
Eligible student excluded and met exemption - Responsible for care of child under 6
Eligible student excluded and met exemption - Single parent, child under 12, enrolled full time
Eligible student excluded and met exemption - State or Federal Work Study

Element 130 - Citizenship and Non-Citizen Status
Nature codes:
001 002 003 096 140 141 142 143 144 145 146 147 148 149 150 151 152 153 -

Eligible person(s) excluded
Ineligible person(s) included
Agency failed to follow up on inconsistent or incomplete information
Policy incorrectly applied
Eligible qualified alien excluded - Amerasians
Eligible qualified alien excluded - Asylees or Deportation Withheld
Eligible qualified alien excluded - Certain American Indians born Abroad
Eligible qualified alien excluded - Children under 18
Eligible qualified alien excluded - Cuban or Haitian Entrant
Eligible qualified alien excluded - Elderly lawfully residing in U.S. age 65 or older on August 22, 19961
Eligible qualified alien excluded - Hmong or Highland Laotian tribal members
Eligible qualified alien excluded - Individuals receiving benefits for blindness or disability
Eligible qualified alien excluded - Iraqi or Afghan Special Immigrants
Eligible qualified alien excluded - LPR with 40 qualifying quarters of work
Eligible qualified alien excluded - LPR with living in US 5 years
Eligible qualified alien excluded - military connection
Eligible qualified alien excluded - Refugee
Eligible qualified alien excluded - Victims of Severe Trafficking

Element 140 - Residency
Nature codes:
003 088 096 099 154 -

Agency failed to follow up on inconsistent or incomplete information
Improper denial or termination, not out of the project area
Policy incorrectly applied
Other
Improper denial - Homeless household denied for failing to provide address

Element 150 - Household Composition
Nature codes:
002 003 006 007 008 009 010 011 096 -

Ineligible person(s) included
Agency failed to follow up on inconsistent or incomplete information
Entitled to separate status
Eligible person(s) with no income, resources, or deductible expenses excluded
Eligible person(s) with income excluded
Eligible person(s) with resources excluded
Eligible person(s) with deductible expenses excluded
Newborn infant improperly excluded
Policy incorrectly applied

Element 151 - Recipient Disqualification
Nature codes:
002 - Ineligible person(s) included
018 - Eligible person(s) disqualified
096 - Policy incorrectly applied
Element 160 - Employment & Training Programs
Nature codes:
004 018 054 060 096 155 -

Agency failed to follow up on known and reported impending changes
Eligible person(s) disqualified
Failure to cooperate with work program when not required to register for work program
Household not notified of requirement to register with work program
Policy incorrectly applied
Individual inappropriately sanctioned

Element 161 - Time-limited participation
Nature codes:
004 018 096 156 157 -

Agency failed to follow up on known and reported impending changes
Eligible person(s) disqualified
Policy incorrectly applied
Improper denial - met ABAWD exemption
Months incorrectly calculated

Element 162 - Work Registration Requirements
Nature codes:
001 002 004 096 158 159 160 161 162 163 164 165 -

Eligible person(s) excluded
Ineligible person(s) included
Agency failed to follow up on known and reported impending changes
Policy incorrectly applied
Eligible person(s) excluded - exempt from work requirements - care for dependent under age 6 or incapacitated person
Eligible person(s) excluded - exempt from work requirements - due to age
Eligible person(s) excluded - exempt from work requirements - employed
Eligible person(s) excluded - exempt from work requirements - participation in drug addiction or alcohol treatment program
Eligible person(s) excluded - exempt from work requirements - physically or mentally unfit
Eligible person(s) excluded - exempt from work requirements - received or applied for unemployment compensation
Eligible person(s) excluded - exempt from work requirements - student enrolled at least half time
Eligible person(s) excluded - exempt from work requirements - subject to and in compliance with TANF work requirements

Element 163 - Voluntary Quit/Reduced Work Effort
Nature codes:
016 017 096 166 167 -

Head of household did not voluntarily quit
Voluntary quit of non-head of household
Policy incorrectly applied
Improper Sanction - entire household sanction for non-head of household voluntarily quit
Household member met good cause

Element 164 - Workfare and Comparable Workfare
Nature codes:
018 - Eligible person(s) disqualified
096 - Policy incorrectly applied
155 - Individual inappropriately sanctioned
Element 165 - Employment Status/Job Availability
Nature codes:
004 - Agency failed to follow up on known and reported impending changes
018 - Eligible person(s) disqualified
096 - Policy incorrectly applied
Element 166 - Acceptance of Employment
Nature codes:
003 - Agency failed to follow up on inconsistent or incomplete information
018 - Eligible person(s) disqualified
096 - Policy incorrectly applied
Element 170 - Social Security Number
Nature codes:
018 020 021 096 -

Eligible person(s) disqualified
Good cause for failure/refusal
Social Security Numbers provided
Policy incorrectly applied
RESOURCES - (200)

Liquid Resources
Element 211 - Bank Accounts or Cash on Hand
Nature codes:
003 024 031 074 096 -

Agency failed to follow up on inconsistent or incomplete information
Resource should have been excluded
Incorrect limit applied
Improper denial - resource counted as income
Policy incorrectly applied

Element 212 - Nonrecurring Lump-sum Payment
Nature codes:
003 004 024 031 074 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Resource should have been excluded
Incorrect limit applied
Improper denial - resource counted as income
Policy incorrectly applied

Element 213 - Other Liquid Assets
Nature codes:
003 - Agency failed to follow up on inconsistent or incomplete information
004 - Agency failed to follow up on known and reported impending changes
024 - Resource should have been excluded

031 - Incorrect limit applied
074 - Improper denial - resource counted as income
096 - Policy incorrectly applied
Non-Liquid Resources
Element 221 - Real Property
Nature codes:
003 004 024 027 028 029 031 074 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Resource should have been excluded
Used for self-employment
Fair market value incorrect
Equity value incorrect
Incorrect limit applied
Improper denial - resource counted as income
Policy incorrectly applied

Element 222 - Vehicles
Nature codes:
003 - Agency failed to follow up on inconsistent or incomplete information
004 - Agency failed to follow up on known and reported impending changes
024 - Resource should have been excluded
027 - Used for self-employment
028 - Fair market value incorrect
029 - Equity value incorrect
031 - Incorrect limit applied
074 - Improper denial - resource counted as income
096 - Policy incorrectly applied
Element 224 - Other Non-Liquid Resources
Nature codes:
003 - Agency failed to follow up on inconsistent or incomplete information
004 - Agency failed to follow up on known and reported impending changes
024 - Resource should have been excluded
027 - Used for self-employment
028 - Fair market value incorrect
029 - Equity value incorrect
031 - Incorrect limit applied
074 - Improper denial - resource counted as income
096 - Policy incorrectly applied
Element 225 - Combined Resources
Nature codes:
022 023 025 026 030 031 096 097 -

Did not transfer resources
Did not exceed limit
Incorrectly applied resources of non-citizen sponsor
Included resources of a non-household member
Does not exceed prescribed limit
Incorrect limit applied
Policy incorrectly applied
Resource counted as income
INCOME (300)

Earned Income
Element 311 - Wages and Salaries
Nature codes:
003 004 032 033 034 035 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Failed to consider or incorrectly considered income of an ineligible member
Rounding used/not used or incorrectly applied
Income from known/processed source included that should not have been
Household unemployed

036 037 038 039 041 042 046 096 168 169 170 -

Conversion to monthly amount not used or incorrectly applied
Averaging not used or incorrectly applied
MRRB household not temporarily over the limit
Employment status changed from unemployed to employed
Change only in amount of earnings
Failed to consider/anticipate month with extra pay date
Failed to consider or incorrectly considered reported information
Policy incorrectly applied
Improper income calculation
Improper calculation - Income included holiday or overtime pay
Improper calculation - Income averaged incorrectly

Element 312 - Self-Employment
Nature codes:
003 004 032 033 034 035 036 037 038 039 041 042 046 096 168 170 171 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Failed to consider or incorrectly considered income of an ineligible member
Rounding used/not used or incorrectly applied
Income from known/processed source included that should not have been
Household unemployed
Conversion to monthly amount not used or incorrectly applied
Averaging not used or incorrectly applied
MRRB household not temporarily over the limit
Employment status changed from unemployed to employed
Change only in amount of earnings
Failed to consider/anticipate month with extra pay date
Failed to consider or incorrectly considered reported information
Policy incorrectly applied
Improper income calculation
Improper calculation - Income averaged incorrectly
Income is Self-Employment income - not identified as Self-Employment

Element 313 - Other Earned Income
Nature codes:
003 004 032 033 034 035 036 037 038 039 041 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Failed to consider or incorrectly considered income of an ineligible member
Rounding used/not used or incorrectly applied
Income from known/processed source included that should not have been
Household unemployed
Conversion to monthly amount not used or incorrectly applied
Averaging not used or incorrectly applied
MRRB household not temporarily over the limit
Employment status changed from unemployed to employed
Change only in amount of earnings
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Deductions
Element 321 - Earned Income Deductions
Nature codes:
043 046 096 125 -

Deduction that should have been included was not
Failed to consider or incorrectly considered reported information
Policy incorrectly applied
Deduction applied to earnings after child support exclusion

Element 323 - Dependent Care Deduction
Nature codes:
043 - Deduction that should have been included was not
046 - Failed to consider or incorrectly considered reported information
096 - Policy incorrectly applied

Unearned Income
Element 331 - RSDI Benefits
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 332 - Veterans Benefits
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 333 - SSI and/or State SSI Supplement
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 334 - Unemployment Compensation
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 335 - Worker's Compensation
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 336 - Other Government Benefits
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 342 - Contributions
Errors in Child Support Payments should not be recorded in this Element. See Element 350.
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 343 - Deemed Income
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 344 - TANF, PA OR GA
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 345 - Educational Grants/Scholarships/Loans
Nature codes:
003 004 034 046096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 346 - Other Unearned Income
Nature codes:
003 004 034 046 096 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied

Element 350 - Child Support Payments Received from Absent Parent
Nature codes:
003 004 034 046 096 111 112 127 170 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Income from known/processed source included that should not have been
Failed to consider or incorrectly considered reported information
Policy incorrectly applied
Child support payments(s) not considered or incorrectly applied for initial month(s) of eligibility
Retained child support payment(s) not considered or incorrectly applied
Pass through not considered or incorrectly applied
Improper calculation - Income averaged incorrectly

Other Deductions
Element 361 - Standard Deduction
Nature codes:
043 - Deduction that should have been included was not
096 - Policy incorrectly applied
Element 363 - Shelter Deduction
Nature codes:
043 047 051 053 096 -

Deduction that should have been included was not
Failed to consider or incorrectly considered Shelter deductions
Incorrect amount used resulting from a change in residence
Incorrectly prorated
Policy incorrectly applied

Element 364 - Standard Utility Allowance
Nature codes:
043 048 050 051 052 053 096 -

Deduction that should have been included was not
Failed to consider or incorrectly considered SUA deductions
Incorrect standard used (Not as a result of a change in household size or move)
Incorrect amount used resulting from a change in residence
Incorrect standard used resulting from a change in household size
Incorrectly prorated
Policy incorrectly applied

Element 365 - Medical Deductions
Nature codes:
043 - Deduction that should have been included was not
045 - Failed to consider or incorrectly considered Medical deductions
096 - Policy incorrectly applied
Element 366 - Child Support Payment Deduction (includes Exclusions)
Nature codes:
040 043 096 111 -

Failed to consider or incorrectly considered Child Support deductions (exclusions)
Deduction (exclusion) that should have been included was not
Policy incorrectly applied
Child support payment(s) not considered or incorrectly applied for initial month(s) of eligibility

Element 371 - Combined Gross Income
Nature codes:
030 - Does not exceed prescribed limit
031 - Incorrect limit applied
096 - Policy incorrectly applied
Element 372 - Combined Net Income
Nature codes:
030 - Does not exceed prescribed limit
031 - Incorrect limit applied
096 - Policy incorrectly applied
Other
Element 412 - Budgeting System
Nature codes:
063 064 065 096 101 -

Deductions excluded that should not have been
Household improperly participating under retrospective budgeting
Household improperly participating under prospective budgeting
Policy incorrectly applied
Simplified reporting household

Element 413 - Application
Nature codes:
059 066 073 076 077 078 079 081 082 096 117 -

Household expedited and should have received postponed verification
Improper denial within 30-day period for missing interview(s)
Improper denial - failed to screen for expedited service
Failed to provide expedited service to expedited eligible household
Failed to issue a required Notice of Missed Interview (NOMI)
Denial before the 30th day
Incorrect use of allotment tables
Late denial agency failed to process the application timely
Improper denial for missing interview when interview never scheduled
Policy incorrectly applied
Failed to process the reapplication timely (recertification application)

Element 414 - Joint TANF/SNAP Processing and Reporting
Nature codes:
067 - Improper termination/denial/suspension when TANF was terminated/ denied
068 - Benefits improperly terminated due to non-submission of monthly report
096 - Policy incorrectly applied
Element 415 - Verification
Nature codes:
003 004 056 069 080 096 102 103 105 172 173 174 175 176 177 178 -

Agency failed to follow up on inconsistent or incomplete information
Agency failed to follow up on known and reported impending changes
Improper Denial/Termination -failure to provide - verification was received or was in case file
Improper denial prior to end of timeframe for providing verification
No application or case record information to support denial/termination/suspension
Policy incorrectly applied
Verification of income requested for a person not associated with current application
Verification of resources requested for a person not associated with current application
Verification was in case file
Improper Denial/Termination - failure to provide - case should have been processed without the deduction
Improper Denial/Termination - failure to provide - categorically eligible household with deemed eligibility elements
Improper Denial/Termination - failure to provide - failed to send a request for contact
Improper Denial/Termination - failure to provide - verification requested was for another program
Improper Denial/Termination - failure to provide - household never notified of needed verification
Improper Denial/Termination - failure to provide - household not given at least 10 days to provide
Improper Denial/Termination - failure to provide - prior to the 30th day

Element 416 - Action Type
Nature codes:
070 071 072 096 -

Improper denial or termination when the case should have been suspended
Improper suspension when the case should have been denied or terminated
Improper termination or suspension for failure to meet reporting requirements
Policy incorrectly applied

Element 511 - Other
Nature codes:
005 012 013 055 084 085 086 087 095 096 099 -

Computer programming error
Computer user error (improper use of system or unauthorized process or work around)
Data entry and/or coding error (includes selection of incorrect codes)
Failure to provide verification for a period of time not associated with current application
Information reported by a bank or financial institution contact inaccurate
Information reported by a collateral contact inaccurate
Information reported by an employer contact inaccurate
Information reported by a landlord contact inaccurate
Other public assistance case was terminated / denied
Policy incorrectly applied
Other. This code is to be used in situations not covered by the other existing element codes.

Element 520 - Arithmetic Computation
Nature codes:
061 - Benefit/allotment/eligibility incorrectly computed
062 - Incorrect use of allotment tables
096 - Policy incorrectly applied
Element 530 - Transitional Benefits
Nature codes:
075 - Eligible for transitional benefits
096 - Policy incorrectly applied

Element 540 - Notices
Nature codes:
049 089 090 091 092 093 094 096 -

Failed to send notice of action
Notice did not include date of intended action
Notice did not include rights of household
Notice not easily understandable
Notice reason does not match reason for action
Notice was not complete
Notice was sent to wrong address
Policy incorrectly applied

RESERVED
This section provides information for the evaluation of the action and case record. This section will be completed for all cases by the State Agency.
ITEM Q.

Accuracy of Recorded Reason - This item indicates the reviewer's evaluation of whether the recorded reason for the agency's
action was in accordance with policy and supported by the information in the case record.
1 - Accurate. Enter this code if the reviewer determined from information in the case record that the reason given for the agency's
action was valid.
2 - Inaccurate. Enter this code if the reviewer determined from information in the case record that the reason given for the agency's
action was invalid.

ITEM R.

Accuracy of Reason on Notice to Household - Enter the appropriate code regarding the analysis of the reason on the notice to the
household.
01 - Accurate. Enter this code if the reviewer determined from all information obtained from the State Agency that the reason on
notice to the household for the agency's action is accurate. If no notice was sent and was not required to be sent, use code 01.
02 - Inaccurate. Enter this code if the reviewer determined from all information obtained from the State Agency that the reason on
notice to the household for the agency's action is not accurate. If no notice was sent and was required to be sent, use code 02.

ITEM S.

Collateral and/or Household Contact - Enter the appropriate code which reflects the decision of the reviewer to make a collateral
and/or household contact. The reason for contacting the collateral source or the household (by telephone or a letter or in person) must
be documented in Section V - Narrative. The narrative must clearly address the element(s) in question.
01 - No collateral or household contact was conducted.
02 - Telephone contact made to a collateral source - information in case record regarding an element(s) was insufficient documented.
03 - Telephone contact made to the household - information in case record regarding an element(s) was insufficient documented.
04 - Letter contact made to a collateral source - information in case record regarding an element(s) was insufficient documented.
The reason for using a letter must be documented on the FNS-245 Section V and a copy of the letter included. The letter must
clearly address the element(s) in question.
05 - Letter contact made to the household - information in case record regarding an element(s) insufficient documented. The
reason for using a letter must be documented on the FNS-245 Section V and a copy of the letter included. The letter must
clearly address the element(s) in question.
06 - Face-to-face contact made to a collateral source - information in case record regarding an element(s) was insufficient
documented.
07 - Face-to-face contact made to the household - information in case record regarding an element(s) was insufficient documented.

ITEM T.

Action Initiated By - Enter the appropriate two digit code to indicate the initial event that prompted the action by the state agency.
This information will be used for administrative purposes and possibly to direct corrective action.
01 - Reported information from the household
02 - Reported information from an automated source
03 - Reported information from other source
04 - Application for assistance submitted by the household
05 - Interim report completed by the household
06 - Interim report not submitted
07 - Failure to provide requested information from an application
08 - Failure to provide requested information from an interim report
09 - Re-certification for assistance submitted by the household
10 - Failure to provide requested information from a re-certification
11 - Other

ITEM U.

NSTR Reason - Enter the code that accurately reflects the reason this action has been determined to be Not Subject To Review.
01 - Households that have withdrawn an application prior to the agency's determination.
02 - Households that at the time of sampling are under active investigation for intentional program violation (IPV).
03 - Households that at the time of sampling are scheduled for an IPV investigation sometime during the next five months.
04 - Households that at the time of sampling are pending an IPV hearing.
05 - Households that have their SNAP case closed when their assigned certification period ends, i.e., the household is not recertified.
The certification period closure itself is NSTR. (If the household applied for recertification and, for whatever reason, the
recertification application was denied, that denial is subject to review).
06 - Actions removed from the sample as a result of a correction for oversampling.
07 - Households that have been sent a notice of pending status but were not actually denied participation.
08 - Actions listed in error. This category of actions includes administrative actions necessitated by a State agency's certification
system and/or procedures, where there is no intent to deny or terminate a household's program benefits, only to correct an
administrative fault in the action.
09 - Households denied SNAP benefits under a disaster certification authorized by FNS.
10 - Actions terminated or suspended for failure to file a complete required report by the extended filing date, but reinstated when
subsequently filed the complete report before the end of the issuance month, and received the full months' SNAP benefits.
11 - Households that experience a break in participation due to computer malfunction or error that is not the result of a deliberate
action by the State agency to terminate benefits. (Use of this code requires prior approval from FNS)
12 - A suspended action after the initial month of a multi-month suspension.

OPTIONAL (FOR STATE SYSTEMS ONLY)
There is one line of spaces available for the State to code information to capture additional data as designated by the State.
SECTION V EXPLANATION OF REVIEW FINDINGS
This section will be used to document the results of the review. The reviewer must record information used to determine the validity of the action and, if
necessary, information on the status of the case as of the review date. The reviewer may document a single element of eligibility or all elements,
depending upon the circumstances of each case. Documentation must be sufficient to support the reviewer's decision on the status of the case (both a
valid and an invalid determination) and the identification of any variances, if the action was found to be invalid.
The narrative should contain a descriptive explanation of the circumstances from the case record regarding why the action was initiated, what
information the agency used to arrive at the decision, what decision was made, and whether the notice that was issued was specific, and clearly
understandable. QC findings should summarize the agreement or disagreement with the actions taken by the agency.
The narrative should answer these questions:
If no notice was sent, is it within the certification guidelines to not send a notice?
The narrative should answer these questions:
Did the action taken reflect what was known by the EW?
Did the EW make a mistake?
Did the notice reflect what the EW thought was happening?
Does the notice indicate what happened?
Is the notice easily understandable and specific about what was happening?
If no notice was sent, is it within the certification guidelines to not send a notice?