Fns 366 B

Form Approved OMB No. 0584-0594
Expiration Date: 06/30/2019

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U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

2. REPORT PERIOD

PROGRAM AND BUDGET SUMMARY STATEMENT
PART B - PROGRAM ACTIVITY STATEMENT
CERTIFICATIONS

(a) APPROVALS

(b) DENIALS

1. STATE

TO

(c) TOTAL APPROVED
AND DENIED

MONTH

YEAR

MONTH

YEAR

(d) 1-30 DAYS

APPROVED OVERDUE APPLICATIONS
(e) 31-60 DAYS
(f) 61-90 DAYS

(g) 91+ DAYS

3. INITIAL APPLICATIONS
4. RECERTIFICATIONS
5. TOTAL
6. EXPEDITED SERVICE
FAIR HEARINGS

(a) HEARINGS
REQUESTED

(b) HEARINGS
HELD

(c) DECISIONS
UPHELD

(d) DECISIONS
REVERSED

(e) DECISIONS
OVERDUE

(f) WITHDRAWN
REQUESTS

7. ACTIVITY
COMBINED
ELIGIBILITY FRAUD
TRAFFICKING
(b)
NO
(a) EVIDENCE
(c) RESULTED (d) AVERAGE #
(f) RESULTED (g) RESULTED IN (h) AVERAGE #
FRAUD
EVIDENCE
(j)
FOUND TO
IN REFERRAL
OF DAYS PER
(e) OPEN
IN REFERRAL NO REFERRAL OF DAYS PER
(i) OPEN
INVESTIGATIONS
FOUND
TO
INVESTIGATOR
REDUCE OR
FOR
ADH
OR
CONCLUDED
INVESTIGATIONS
FOR
ADH
OR
FOR
ADH
OR
CONCLUDED
INVESTIGATIONS
REDUCE OR
HOURS
DENY BENEFITS DENY
PROSECUTION PROSECUTION INVESTIGATION
BENEFITS PROSECUTION INVESTIGATION
8. CASES/DAYS/
HOURS
ELIGIBILITY FRAUD

TRAFFICKING

COMBINED

(c) ADH
(g) ADH
ADMINISTRATIVE
(a) ADH
(b) WAIVER CONCLUDED,
(e) ADH
(f) WAIVER CONCLUDED,
(d) AMOUNT CONCLUDED,
(h) AMOUNT
DISQUALIFICATION CONCLUDED,
SIGNED,
SIGNED,
INDIVIDUAL
SUBJECT
INDIVIDUAL
SUBJECT
HEARINGS
INDIVIDUAL
INDIVIDUAL
INDIVIDUAL
INDIVIDUAL
NOT
TO CLAIM DISQUALIFIED DISQUALIFIED
NOT
TO CLAIM
DISQUALIFIED DISQUALIFIED DISQUALIFIED
DISQUALIFIED

REFERRED INDIVIDUALS
AWAITING SCHEDULING
(i)
91-180 DAYS

(j)
181+ DAYS

(k) DECISION
NOTICES
OVERDUE

9. INDIVIDUALS/
$/NOTICES
ELIGIBILITY FRAUD
(a) PROSECUTION (b) DCA SIGNED, (c) PROSECUTION
PROSECUTIONS
CONCLUDED,
CONCLUDED,
INDIVIDUAL
INDIVIDUAL NOT
INDIVIDUAL
DISQUALIFIED
DISQUALIFIED
DISQUALIFIED

TRAFFICKING
(d) AMOUNT
SUBJECT
TO CLAIM

(e) PROSECUTION (f) DCA SIGNED, (g) PROSECUTION
CONCLUDED,
CONCLUDED,
INDIVIDUAL
INDIVIDUAL
INDIVIDUAL NOT
DISQUALIFIED
DISQUALIFIED
DISQUALIFIED

COMBINED
(h) AMOUNT
SUBJECT
TO CLAIM

(i) AVERAGE # OF
DAYS PER
CONCLUDED
PROSECUTION

10. INDIVIDUALS/
$/DAYS

FNS-366B (11/15) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 10.0 Version

FNS-366B INSTRUCTIONS
CERTIFICATIONS:

LINE 6 - EXPEDITED SERVICE

This section identifies the number of SNAP initial and
recertification applications that were approved or denied, and the
total applications processed, and the number of applications that
were approved beyond processing requirements. The entries in
each line item must be determined independent of the other line
item entries. Counts entered into column (b), Denials, should
only include those applications which were denied due to
ineligibility. Do not include closed cases. Count only SNAP
applications that were processed to a determination and do not
count withdrawals or disaster applications. Counts should
represent applications that were approved, denied and overdue
during the reporting period of this form.

Report the total number of SNAP applications that were
approved for and received expedited service during the report
period in column 6(a). Of the expedited applications approved in
6(a), report the total number of applications screened as eligible
for expedited service that were approved late during the report
period by 1 and 30 days 6(d), 31 and 60 days 6(e), 61 and 90
days 6(f) and over 91 days 6(g). For example, if an application is
approved 73 days after the date of application and that
application met expedited service criteria, the application should
be included in the count in column 6(f).

LINE 3 - INITIAL APPLICATIONS:

LINE 7 - ACTIVITY

Report the total number of initial applications that were approved
3(a) and denied 3(b) during the report period. Calculate the total
number of initial applications 3(c) by adding 3(a)+3(b). Of the
initial applications approved in3(a), report the number of those
applications approved overdue during the report period by 1 and
30 days 3(d), 31 and 60 days 3(e), 61 and 90 days 3(f) and over
91 days 3(g). For example,if an application was approved 43
days after the date of application, the application should be
reported in the count in column 3(e).

(a) HEARINGS REQUESTED - Report the total number of fair
hearings requested during the report period.

LINE 4 - RECERTIFICATIONS:
Report the number of SNAP recertification applications that were
approved 4(a) and denied 4(b) during the report period.
Calculate the total number of recertification applications 4(c) by
adding 4(a)+4(b). Of the recertification applications approved in
4(a), report the number of those recertification applications that
were approved overdue during the report period by 1 and 30
days 4(d), 31 and 60 days 4(e), 61 and 90 days 4(f) and over 91
days 4(g).
LINE 5 - TOTAL
Report the total number of SNAP initial and recertification
applications approved in 5(a) by adding 3(a)+4(a), denied in 5(b)
by adding 3(b)+4(b), and total number processed in 5(c) by
adding 3(c)+4(c). Report the total number of SNAP initial and
recertification applications approved overdue during the report
period by 1 and 30 days in 5(d) by adding 3(d)+4(d), between 31
and 60 days in 5(e) by adding 3(e)+4(e), between 61 and 90
days in 5(f) by adding 3(f)+4(f), and over 91 days in 5(g) by
adding 3(g)+4(g). Totals should represent all applications that
were received and processed to a determination during the
report period.

FAIR HEARINGS

(b) HEARINGS HELD - Report the total number of fair hearings
that were held during the report period.
(c) DECISIONS UPHELD - Report 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 - Report 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 OERDUE - Report the total number of fair
hearing decisions rendered during the report period that were
not made within the specified time frames.
(f) WITHDRAWN REQUESTS - Report the total number of fair
hearing requests that were withdrawn during the report
period. Include no shows in the count of withdrawns.

FNS-366B INSTRUCTIONS
FRAUD INVESTIGATIONS
This section reflects activity of fraud control unit(s), or similar
investigative entities, within a State to investigate individuals
suspected of SNAP eligibility fraud and/or trafficking benefits.
Investigations are: Effort by designated investigators (or
investigator's representatives) to develop a record of fact used to
determine whether sufficient documentary evidence of SNAP
fraud or abuse exists to warrant civil, criminal or administrative
legal action against an individual.
Investigations are not: Eligibility worker activity to verify
information obtained through a data match at certification or
recertification unless additional action by a SNAP investigator is
required.
Each investigation (case) must be reported under either Eligibility
Fraud or Trafficking, and, when applicable, Combined. The type
of fraud that most appropriately reflects the matter investigated
must be determined for each investigation. A case wherein
multiple people are investigated is counted as one case.
LINE 8 - CASES / DAYS / HOURS
ELIGIBILITY FRAUD: Investigated individual(s) was/is
suspected of intentionally making a false or misleading
statement, or misrepresenting, concealing or withholding facts at
application, required reporting, or recertification period with the
intent to influence a SNAP eligibility determination.
(a) EVIDENCE FOUND TO REDUCE OR DENY BENEFITS Report the total number of eligibility fraud investigations
(cases) that concluded with a finding of sufficient evidence to
reduce or deny benefits of investigated individual(s). This
includes both investigations concluded before certification
that affect the final determination of eligibility/benefit
allotment, and investigations concluded after certification that
affect ongoing eligibility/benefit allotment.
(b) NO EVIDENCE FOUND TO REDUCE OR DENY BENEFITSReport the total number of eligibility fraud investigations
(cases) that concluded without a finding of sufficient evidence
to reduce or deny benefits investigated individuals. This
includes investigations where allegations/suspicions are not
corroborated, allegations/suspicions are corroborated, but do
not impact eligibility/benefit allotment, and investigations that
are canceled or suspended without a final determination of
guilt.
(c) RESULTED IN REFERRAL FOR ADH OR PROSECUTION Of the eligibility fraud investigations reported in box 8(a),
report the total number of concluded investigations (cases)
that resulted in the referral of an individual for an
Administrative Disqualification Hearing or Prosecution due to
a suspected Intentional Program Violation. Count only
investigations, not individuals. For example, if a single
investigation of a household leads to the referral of multiple
individuals for ADH or prosecution, count the investigation
only once. ADH and prosecution outcomes for individuals
are reported on lines 9 and 10.

(d) AVERAGE # OF DAYS PER CONCLUDED INVESTIGATION Report the average length in days of all eligibility fraud
investigations (cases) reported in 8(a) and 8(b): determine for
each eligibility fraud investigation the total days from the day a
case was referred for investigation to the day the investigation
concluded and/or was canceled. Sum together the individual
investigation lengths. Then, divide this sum by the total of 8(a)
+ 8(b). For cases that require additional investigation after
ADH/prosecution referral is made, consider the referral date as
the conclusion date.
(e) OPEN INVESTIGATIONS - Report the number of ongoing/
unresolved eligibility fraud investigations (cases) at the time of
reporting.
TRAFFICKING: Investigated individual(s) was/is suspected of
trafficking benefits: see 7 CFR §271.2 Definitions.
(f) RESULTED IN REFERRAL FOR ADH OR PROSECUTION Report the total number of trafficking investigations (cases)
that concluded with a finding of sufficient evidence to refer
recipient(s) for Administrative Disqualification Hearing and/or
Prosecution.
(g) RESULTED IN NO REFERRAL FOR ADH OR
PROSECUTION - Report the total number of trafficking
investigations (cases) that concluded without a finding of
sufficient evidence to refer recipient(s) for Administrative
Disqualification Hearing and/or Prosecution.
(h) AVERAGE # OF DAYS PER CONCLUDED INVESTIGATION
- Report the average length in days of all trafficking
investigations (cases) reported in boxes 8(f) and 8(g):
Determine for each trafficking investigation the total days from
the day the case was referred for investigation to the day the
investigation concluded. Sum together the individual lengths.
Then, divide this sum by the total of 8(f) + 8(g). For cases that
require additional investigation after ADH/prosecution referral
is made, consider the referral date as the conclusion date.
(i) OPEN INVESTIGATIONS - Report the number of ongoing/
unresolved trafficking investigations (cases) at the time of
reporting.
COMBINED: Include all SNAP investigations.
(j) INVESTIGATOR HOURS - Report the total paid investigator
hours that were eligible for FNS 50/50 reimbursement within
the State during the report period. This amount can be
determined by: using the actual hours used to calculate FNS
reimbursement over the report period; or, by calculating a sum
based on the designated percentage of total hours worked in a
report period that an investigator, or investigators combined,
spent on SNAP activity; or, by equivalent means appropriate
for the State.

FNS-366B INSTRUCTIONS
ADMINISTRATIVE DISQUALIFICATION HEARINGS

COMBINED: Include all concluded ADHs.

This section reflects action taken against individuals referred for
an administrative disqualification hearing (ADH) after an
investigation yielded sufficient documentary evidence to
substantiate and pursue an IPV.

(i) REFERRED INDIVIDUALS AWAITING SCHEDULING: 91-180
DAYS - Report the total number of individuals that were
referred for ADH over 90 days before the time of reporting that
have not received a scheduled date for their hearing.

Each individual must be reported under either Eligibility Fraud or
Trafficking, and, when applicable, Combined. The type of fraud
that most appropriately reflects the case circumstances must be
determined for each individual. Count each accused person that
completed an ADH or signed a waiver individually.

(j) REFERRED INDIVIDUALS AWAITING SCHEDULING: 181+
DAYS - Report the total number of individuals that were
referred for ADH over 180 days before the time of reporting
that have not received a scheduled date for their hearing.

LINE 9 - INDIVIDUALS / $ / NOTICES
ELIGIBILITY FRAUD: Referred individual accused of intentionally
making a false or misleading statement, or misrepresenting,
concealing or withholding facts at application, required reporting,
or recertification period with the intent to influence a SNAP
eligibility determination.
(a) ADH CONCLUDED, INDIVIDUAL DISQUALIFIED - Report the
number of individuals that were disqualified after the ADH
hearing officer confirmed the commission of an eligibility fraud
IPV. Do not include waivers.
(b) WAIVER SIGNED, INDIVIDUAL DISQUALIFIED - Report the
number of individuals that were disqualified after signing a
Waiver of Right to an ADH for an eligibility fraud IPV.
(c) ADH CONCLUDED, INDIVIDUAL NOT DISQUALIFIED Report the number of individuals for whom the hearing official
rendered a ruling that did not confirm the commission of an
eligibility fraud IPV.
(d) AMOUNT SUBJECT TO CLAIM - Report the estimated dollar
value of benefits that may be recovered due to the eligibility
fraud disqualifications counted in 9(a) and 9(b). Sum all
individual dollar value determinations, and report the total
amount.

(k) DECISIONS NOTICES OVERDUE - Report the number of
ADH decision notices issued in the report period that did not
meet the 90-day (plus household-requested postponement
days) requirement prescribed at 7 CFR 273.16(e)(2)(iv).
PROSECUTIONS
This section reflects action taken against individuals referred for
civil or criminal prosecution after an investigation yielded sufficient
documentary evidence to substantiate and pursue an IPV through
the appropriate court of jurisdiction.
Each individual must be counted under either Eligibility Fraud or
Trafficking and, when applicable, Combined. The type of fraud
that most appropriately reflects the case circumstances must be
determined for each individual. Count each accused person that
completed prosecution or signed a DCA individually.
LINE 10 - INDIVIDUALS / $ / DAYS
ELIGIBILITY FRAUD: Referred individual charged with
intentionally making a false or misleading statement, or
misrepresenting, concealing or withholding facts at application,
required reporting, or recertification period with the intent to
influence a SNAP eligibility determination.

TRAFFICKING: Referred individual accused of: see 7 CFR
§271.2 Definitions.

(a) PROSECUTION CONCLUDED, INDIVIDUAL DISQUALIFIED
- Report the number of individuals that were disqualified after
a court ruling confirmed the commission of SNAP eligibility
fraud. Do not include DCAs or similarly enforceable
prosecutorial agreements.

(e) ADH CONCLUDED, INDIVIDUAL DISQUALIFIED - Report the
number of individuals that were disqualified after the ADH
hearing officer confirmed the commission of a trafficking IPV.
Do not include waivers.

(b) DCA SIGNED, INDIVIDUAL DISQUALIFIED - Report the
number of individuals that were disqualified after signing a
disqualification consent agreement or similarly enforceable
prosecutorial agreement for SNAP eligibility fraud.

(f) WAIVER SIGNED, INDIVIDUAL DISQUALIFIED - Report the
number of individuals that were disqualified after signing a
Waiver of Right to an ADH for a trafficking IPV.

(c) PROSECUTION CONCLUDED, INDIVIDUAL NOT
DISQUALIFIED - Report the number of individuals for whom
the prosecution resulted in an acquittal, or a ruling or
agreement otherwise insufficient to enforce a disqualification
for SNAP eligibility fraud.

(g) ADH CONCLUDED, INDIVIDUAL NOT DISQUALIFIED Report the number of individuals for whom the hearing official
rendered a ruling that did not confirm the commission of a
trafficking IPV.
(h) AMOUNT SUBJECT TO CLAIM - Report the estimated dollar
value of benefits that may be recovered due to the trafficking
disqualifications counted in 9(e) and 9(f). Sum all individual
dollar value determinations, and report the total recoverable
amount.

(d) AMOUNT SUBJECT TO CLAIM - Report the estimated dollar
value of benefits that may be recovered due to the eligibility
disqualifications counted in 10(a) and 10(b). Sum all individual
dollar value determinations, and report the total amount.

FNS-366B INSTRUCTIONS
TRAFFICKING: Referred individual charged with: see 7 CFR
§271.2 Definitions.
(e) PROSECUTION CONCLUDED, INDIVIDUAL
DISQUALIFIED - Report the number of individuals that were
disqualified after a court ruling confirmed the trafficking of
SNAP benefits. Do not include DCAs or similarly enforceable
prosecutorial agreements.
(f) DCA SIGNED, INDIVIDUAL DISQUALIFIED - Report the
number of individuals that were disqualified after signing a
disqualification consent agreement or similarly enforceable
prosecutorial agreement for trafficking SNAP benefits.
(g) PROSECUTION CONCLUDED, INDIVIDUAL NOT
DISQUALIFIED - Report the number of individuals for whom
the prosecution resulted in an acquittal, or a ruling or
agreement otherwise insufficient to enforce a disqualification
for trafficking SNAP benefits.
(h) AMOUNT SUBJECT TO CLAIM - Report the estimated dollar
value of benefits that may be recovered due to the trafficking
disqualifications counted in 10(e) and 10(f). Sum all individual
dollar value determinations, and report the total amount.
COMBINED: Include all concluded prosecutions.
(i) AVERAGE # OF DAYS PER CONCLUDED PROSECUTIONReport the average length in days of all prosecutions reported
in 10(a), 10(b), 10(c), 10(e), 10(f), and 10(g): Determine for
each prosecution the total days from the day a case was
referred for prosecution to the day the prosecution concluded.
Sum together individual prosecution lengths. Then, divide this
sum by the total of 10(a) + 10(b) + 10(c) + 10 (e) + 10(f) +
10(g). Consider cases concluded the day of conviction, of
acquittal, a DCA is signed, an agreement with the court is
reached, adjudication is initially deferred, or a similar
resolution is reached. If a deferment or agreement is
rescinded due to defendant fault, the date of the final
resolution may be used when known.

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 0584-0594. The time
required to complete this information collection is estimated to
average 15-30 hours per response, including the time to review
instructions, search existing data resources, gather the data
needed, complete and review the information collection.