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

FORM APPROVED OMB NO. 0584-0083
Expiration Date: XX/XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE A. STATE

PROGRAM AND BUDGET SUMMARY STATEMENT
PART B - PROGRAM ACTIVITY STATEMENT

B. REPORT PERIOD (State's FY)
Month

C. CERTIFICATIONS

(A) APPROVAL

(B) DENIALS

Year

TO

Month

Year

(C) TOTAL

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

D. FAIR HEARINGS

(A) HEARINGS
REQUESTED

(B) HEARINGS (C) DECISIONS (D) DECISIONS (E) DECISIONS (F) WITHDRAWN
HELD
UPHELD
REVERSED
OVERDUE
REQUESTS

1. ACTIVITY

E. FRAUD INVESTIGATIONS

INVEST COMPLETED

(A) REFERRED
FOR INVEST.

(B) NEGATIVE

(A) CASES
(PERSONS)
REFERRED

(B) CASES
PURSUED

(C) POSITIVE

(D) PROGRAM
DOLLARS

(E) INVEST
PENDING

(F) INVEST
CANCELLED

(E) ACTUALLY
ACQUITTED

(F) PROGRAM
DOLLARS

1. PRE-CERTIFICATION
2. POST-CERTIFICATION
F. DISQUALIFICATION
HEARINGS AND
PROSECUTIONS
1. ADMINISTRATIVE DISQUALIFICATION HEARING

(C) WAIVERS
(D) UPHELD
DISQ CONSENT CONVICTIONS
AGREEMENT

(G) PENDING
DECISIONS

(H) DECISIONS
OVERDUE

2. PROSECUTIONS
DATE
FORM FNS-366B (01-07)

SIGNATURE

TITLE
Electronic Form Version Designed in Adobe 7.1 Version

INSTRUCTIONS
FORM FNS-366B
C CERTIFICATION: This section identifies the number of initial and
recertification applications that were approved or denied, and the
total applications processed. The entries in each line item must be
determined independent of the other line item entries.
(A)

1 through (C) 3: Enter the annual cumulative total number of
initial and recertification applications that were approved, or
denied, and the total number of processed applications during
the report period. Count only regular FSP applications that
were processed to a determination and do not count
withdrawals or disaster applications. For reporting totals in this
section, A1+B1=C1 and A1+A2=A3. Enter in (A) 4 the total
number of applications that were approved for and received
expedited service.

D FAIR HEARINGS: This section shall provide the results of the
requests for a hearing. The entries in each line item must be
determined independent of the other line item entries.

Line 2 Post-Certification
(A)

Referred for Investigation - Enter the number of initial application
cases that were referred for pre-certification investigation and the
investigation was not completed before the eligibility determination,
and all other cases referred for investigation during the report period.

(B)

Investigation Completed, Negative - Enter the number of cases for
which an investigation was completed before the end of the report
period and no indication of a program violation was found.
Investigations Completed, Positive - Enter the number of cases for
which an investigation was completed before the end of the report
period and referred for an ADH or for Prosecution.
Program Dollars - For the cases reported in item E 2, (C), enter the
potential dollar value of program loss that may be recovered if the
suspected program violation is substantiated by an ADH or the courts.
Investigations Pending - Enter the number of cases for which an
initiated investigation had not been completed before the end of the
report period, or an investigation had not been initiated before the end
of the report period.
Investigations Canceled - Enter the number of cases in which an
investigation had been initiated but canceled before the end of the
report period.

(C)
(D)
(E)

Line 1 Activity
(A) Hearings Requested - Enter the total number of fair hearings
requested during the report period.
(B) Hearings Held - Enter the total number of fair hearings that were
held during the report period.
(C) Decisions Upheld - Enter the total number of fair hearings that
were held during the report period that resulted in the State
agency's action being upheld.
(D) Decisions Reversed - Enter the total number of fair hearings that
were held during the report period that resulted in the State
agency's action being reversed.
(E) Decisions Overdue - Enter the total number of fair hearing decisions
rendered during the report period that were not made within the
specified timeframes.
(F) Withdrawn Requests - Enter the total number of fair hearing requests
that were withdrawn during the report period. Include no shows in
the count of withdrawns.
E

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

Line 1 Pre-Certification
(A)
(B)
(C)

(D)

(E)

(F)

Referred for Investigation - Enter the number of pre-certification
applications referred during the report period.
Investigations Completed, Negative - Enter the number of
investigations that were completed within the application processing
timeframe and no indication of a program violation was found.
Investigations Completed, Positive - Enter the number of
investigated cases that were completed within the application
processing timeframe that were denied eligibility.
Program Dollars - For the cases reported in item E 1, (C), enter the
potential dollar value of benefits the household would have received
for the first full month of eligibility if a suspected program violation
had not been detected before the eligibility determination.
Investigations Pending - Enter the number of cases for which: an
initiated investigation had not been completed by the end of the
application processing timeframe; an initiated investigation had not
been completed before the end of the reporting period; or an
investigation had not been initiated before the end of the report
period.
Investigations Canceled - Enter the number of cases for which an
investigation had been initiated but canceled before the end of the
report period.

(F)

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

Waivers - Enter the number of cases for which the accused person
signed a Waiver of Right to an ADH during the report period.

(D)

Upheld - Enter the number of cases for which the hearing officer
upheld the agency's suspicion of an IPV.

(E)

Actually Acquitted - Enter the number of cases for which the hearing
officer found the person not guilty of committing an IPV.

(F)

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

Decisions Pending - Enter the number of cases reported in item F 1,
(B) for which the hearing official's decision is not due (within
established timeframes) to be rendered before the end of the report
period.
(H) Decisions Overdue - Enter the number of cases that were pursued in
which the decisions were rendered later than the prescribed time
frames.
Line 2 Prosecutions
(G)

(A)

Cases (Persons) Referred - Enter the number of cases referred for
prosecution by the courts during the report period.

(B)

Cases Pursued - Enter the number of cases referred which were
accepted by the prosecutor during the report period.
Disqualification Consent Agreement - Enter the number of cases for
which adjudication is deferred as the accused persons admitted guilt
by signing the Disqualification Consent Agreement waiving their right
to prosecution by the courts during the report period.
Convictions - Enter the number of cases found guility of committing an
IPV by the courts during the report period.

(C)

(D)
(E)

Actually Acquitted - Enter the number of cases found not guility of
committing an IPV by the courts during the report period.

(F)

Program Dollars - For the cases reported in items F 2, (C), and (D),
enter the estimated dollar value of program loss that may be
recovered.
Decisions Pending - Enter the number of cases for which the cases
were heard but the court's decision was not formally rendered before
the end of the report period.

(G)

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