Form FNS-245 Quality Control - SNAP Case and Procedural Case Action R

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

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

B. TELEPHONE NUMBER

C. MAILING ADDRESS

D. ACTUAL ADDRESS/DIRECTIONS TO LOCATE

E. DATE ASSIGNED
MONTH

F. DATE COMPLETED/DISPOSED OF
DAY

YEAR

MONTH

DAY

G. DATE CLEARED

YEAR

MONTH

Reviewer

DAY

YEAR

Supervisor

II. IDENTIFYING INFORMATION
1. REVIEW NUMBER

5. STRATUM

2. CASE NUMBER

3. STATE AND LOCAL AGENCY CODE

6. NOTICE DATE

7. ACTION DATE

DAY

MONTH

YEAR

DAY

MONTH

4. SAMPLE MONTH AND YEAR

8. ACTION TYPE

9. CASE CLASSIFICATION

YEAR

III. ANALYSIS OF REVIEW ACTIVITY
10. DISPOSITION OF REVIEW
a) Disposition

11. FINDING

b) NSTR Reason

12. CASE RECORD REVIEW
a) Recorded Reason for Action

13. NOTICE REQUIREMENT
b) Accuracy of Recorded Reason

14. HOUSEHOLD NOTICE
a) Required Language

c) Reason to HH

b) Notice Specific, Clear, Understandable

d) Accuracy of Reason to HH

15. PROCEDURAL REQUIREMENTS
a) Notice of Missed Interview

b) Request for Contact

c) Request for Verification

d) Periodic Report

16. TIMELINESS OF ACTION
a) Timeliness of Action

b) Number of Days Action Early/Late

c) Timeliness of Notice

d) Number of Days Notice Late

IV. DESCRIPTION OF VARIANCES
17. ELEMENT CODE

1.

18. NATURE CODE

2.

3.

1.

2.

3.

RESERVED CODING
19. COLLATERAL/HOUSEHOLD CONTACT

20. ACTION INITIATED BY

RESERVED FOR FUTURE USE

OPTIONAL (STATE SYSTEMS ONLY)

V. EXPLANATION OF REVIEW FINDINGS

FORM FNS-245 (01/14) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 10.0 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 non-compliance.

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.

INSTRUCTIONS FOR COMPLETING FORM FNS-245,
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
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 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.

A.

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

B.

Telephone Number – Enter the telephone number of the household.

C.

Mailing Address – Enter the mailing address of the household.

D.

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

E.

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

F.

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.

G.

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 action under review. For all actions, fill in 1 through 9.

1.

Review Number – Enter the number assigned to the action under review.

2.

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

3.

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.

4.

Sample Month and Year – Enter the month and year for which the action was selected for review. The sample month for an
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.

5.

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.

6.

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

7.

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

8.

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

9.

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 10 through 20. For cases that are not subject to
review fill in 10(a) and 10(b).

10.

Disposition of Review

(a)

Disposition – Enter the appropriate code that reflects the disposition of the review.
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. 10(b) is required. 11-20 are not required.
3 – Incomplete/Review Not Processed. Prior FNS approval is required for use of this code.
4 – Case deselected/correction for oversampling. No further codes are required.

(b)

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 monthly 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

11.

Finding – Final Analysis of the QC Review of the Action - Enter the appropriate code to identify if 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.
1 – Valid indicates that all three components were correct.
2 – Invalid indicates that one or more of the three components were incorrect. For example if 12(b)=2 then the case must
be coded invalid.

12.

Case Record Review

(a)

Recorded Reason for Action – Enter the appropriate code to indicate the reason the action was taken by the
state agency as reflected by the entire case record. This is not necessarily the reason stated on the notice to the
household.
01 – Resident of an institution not authorized by FNS
02 – Outside of project area or State
03 – Ineligible striker
04 – Ineligible noncitizen
05 – Ineligible student
06 – Ineligible boarder
07 – Missed scheduled interview(s)
08 – Failed to provide verification
09 – Refusal to cooperate
10 – Refusal to supply SSN
11 – Gross monthly income exceeds maximum allowance
12 – Net Monthly income exceeds maximum allowance
13 – Exceeds resource standard
14 – Transfer of resources
15 – Failure to comply, without good cause, with work registration/job search requirements
16 – Voluntary quit
17 – Failure to submit/complete report
18 – Voluntary withdrawal after certification
19 – Termination/denial due to TANF termination/denial
20 – Intentional program violation
21 – Termination/denial due to program disqualification
22 – 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 – Cannot be determined

(b)

Accuracy of Recorded Reason – Enter the appropriate code to indicate 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. The information in the case record supports the reason given for the agency's action.
2 – Inaccurate. The information in the case record does not support the reason given for the agency's action.
3 – Insufficient information. There is not enough information in the case record to determine the accuracy of the
recorded reason for action.

13.

Notice Requirements – Enter the appropriate code to indicate if the notice of denial, termination or suspension was required to
be sent and if the notice was sent.
1 – Notice was required and sent.
2 – Notice was required and not sent.
3 – No requirement to issue a notice on this action and did send notice.
4 – No requirement to issue a notice on this action and did not send.

14.

Household Notice

(a)

Required Language on the Notice of Adverse Action/Denial – Enter the code that reflects if the notice
contains all required language as specified by the Food and Nutrition Act of 2008, Regulations, and FNS Policy
Memos.
1 – All Required Language/Information Included
2 – All Required Language/Information Not Included
3 – No notice sent to household

(b)

Notice Specific, Clear, and 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. 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
understandable for the action.
2 – No, either the reason for the action stated on the notice is not specific, or the notice is not clear or the notice is
not understandable for the action; or any combination of the three. A detailed and thorough explanation is
required in Section V.
3 – No notice sent to household.

(c)

Reason to HH – Enter the appropriate code to indicate the reason for the action as written on the notice.
01 – Resident of an institution not authorized by FNS
02 – Outside of project area or State
03 – Ineligible striker
04 – Ineligible noncitizen
05 – Ineligible student
06 – Ineligible boarder
07 – Missed scheduled interview(s)
08 – Failed to provide verification
09 – Refusal to cooperate
10 – Refusal to supply SSN
11 – Gross monthly income exceeds maximum allowance
12 – Net Monthly income exceeds maximum allowance
13 – Exceeds resource standard
14 – Transfer of resources
15 – Failure to comply, without good cause, with work registration/job search requirements
16 – Voluntary quit
17 – Failure to submit/complete report
18 – Voluntary withdrawal after certification
19 – Termination/denial due to TANF termination/denial
20 – Intentional program violation
21 – Termination/denial due to program disqualification
22 – 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

(d)

Accuracy of Reason on Notice to Household – Enter the appropriate code to indicate if the reason on the
notice to the household was in accordance with policy and supported by the information in the case record and if
the reason matches 12(a), the recorded reason for the action.
11 – Accurate, matches recorded reason.
12 – Accurate, does not match recorded reason.
21 – Inaccurate, matches recorded reason.
22 – Inaccurate, does not match recorded reason.
99 – No notice sent to household.

15.

Procedural Requirements – This section must be filled out for all completed reviews.

(a)

Notice of Missed Interview – NOMI
1 – Required and completed correctly
2 – Required and not completed correctly
3 – Not required

(b)

Request for Contact
1 – Required and completed correctly
2 – Required and not completed correctly
3 – Not required

(c)

Request for Verification
1 – Required and completed correctly
2 – Required and not completed correctly
3 – Not required

(d)

Periodic Report
1 – Required and sent to household
2 – Required and not sent to household
3 – Not required

16.

Timeliness of the Action

(a)

Timeliness of Action – Enter the appropriate code to identify if the action was taken within the appropriate
timeframes.
1 – Action taken timely
2 – Action taken too early
3 – Action taken late

(b)

Number of Days Action Early/Late – If the Action was taken early or late, enter the number of days early or late.
Enter 99 for 99+ days late.

(c)

Timeliness of Notice – Enter the appropriate code to identify if the notice was sent within the appropriate
timeframes.
1 – Notice sent timely
2 – Notice sent late
3 – No notice sent

(d)

Number of Days Notice Late – If the Notice was sent late, enter the number of days late. Enter 99 for 99+ days
late.

SECTION IV DESCRIPTION OF VARIANCES
This section provides for the description of variances identified in the review. 17 and 18 must be completed whenever the final
determination for 11 is invalid (code 2).

17.

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

18.

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.
Element 111 – Student Status
Nature codes:
001 – Eligible person(s) excluded
002 – Ineligible person(s) included
003 – Agency failed to follow up on inconsistent or incomplete information
014 – Eligible student incorrect income
015 – Eligible student incorrect student deductions
019 – Eligible student was denied for failing to verify student status which was previously verified
044 – Failed to consider or incorrectly considered Eligible Student status
096 – Policy incorrectly applied
131 – Eligible student excluded and met exemption – 17 and younger / 50 and older
132 – Eligible student excluded and met exemption – Enrollment as part of Job
133 – Eligible student excluded and met exemption – On-the-job training
134 – Eligible student excluded and met exemption – Employment requirements met
135 – Eligible student excluded and met exemption – Physically or mentally unfit
136 – Eligible student excluded and met exemption – Receiving TANF
137 – Eligible student excluded and met exemption – Responsible for care of child under 6
138 – Eligible student excluded and met exemption – Single parent, child under 12, enrolled full time
139 – Eligible student excluded and met exemption – State or Federal Work Study
Element 130 – Citizenship and Non-Citizen Status
Nature codes:
001 – Eligible person(s) excluded
002 – Ineligible person(s) included
003 – Agency failed to follow up on inconsistent or incomplete information
096 – Policy incorrectly applied
140 – Eligible qualified alien excluded – Amerasians
141 – Eligible qualified alien excluded – Asylees or Deportation Withheld
142 – Eligible qualified alien excluded – Certain American Indians born Abroad
143 – Eligible qualified alien excluded – Children under 18
144 – Eligible qualified alien excluded – Cuban or Haitian Entrant
145 – Eligible qualified alien excluded – Elderly lawfully residing in U.S. age 65 or older on August 22, 1996
146 – Eligible qualified alien excluded – Hmong or Highland Laotian tribal members
147 – Eligible qualified alien excluded – Individuals receiving benefits for blindness or disability
148 – Eligible qualified alien excluded – Iraqi or Afghan Special Immigrants
149 – Eligible qualified alien excluded – LPR with 40 qualifying quarters of work
150 – Eligible qualified alien excluded – LPR with living in US 5 years
151 – Eligible qualified alien excluded – military connection
152 – Eligible qualified alien excluded – Refugee
153 – Eligible qualified alien excluded – Victims of Severe Trafficking
Element 140 – Residency
Nature codes:
003 – Agency failed to follow up on inconsistent or incomplete information
088 – Improper denial or termination, not out of the project area
096 – Policy incorrectly applied
099 – Other
154 – Improper denial – Homeless household denied for failing to provide address

Element 150 – Household Composition
Nature codes:
002 – Ineligible person(s) included
003 – Agency failed to follow up on inconsistent or incomplete information
006 – Entitled to separate status
007 – Eligible person(s) with no income, resources, or deductible expenses excluded
008 – Eligible person(s) with income excluded
009 – Eligible person(s) with resources excluded
010 – Eligible person(s) with deductible expenses excluded
011 – Newborn infant improperly excluded
096 – 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 – Agency failed to follow up on known and reported impending changes
018 – Eligible person(s) disqualified
054 – Failure to cooperate with work program when not required to register for work program
060 – Household not notified of requirement to register with work program
096 – Policy incorrectly applied
155 – Individual inappropriately sanctioned
Element 161 – Time-limited participation
Nature codes:
004 – Agency failed to follow up on known and reported impending changes
018 – Eligible person(s) disqualified
096 – Policy incorrectly applied
156 – Improper denial – met ABAWD exemption
157 – Months incorrectly calculated
Element 162 – Work Registration Requirements
Nature codes:
001 – Eligible person(s) excluded
002 – Ineligible person(s) included
004 – Agency failed to follow up on known and reported impending changes
096 – Policy incorrectly applied
158 – Eligible person(s) excluded – exempt from work requirements – care for dependent under age 6 or incapacitated person
159 – Eligible person(s) excluded – exempt from work requirements – due to age
160 – Eligible person(s) excluded – exempt from work requirements – employed
161 – Eligible person(s) excluded – exempt from work requirements – participation in drug addiction or alcohol treatment program
162 – Eligible person(s) excluded – exempt from work requirements – physically or mentally unfit
163 – Eligible person(s) excluded – exempt from work requirements – received or applied for unemployment compensation
164 – Eligible person(s) excluded – exempt from work requirements – student enrolled at least half time
165 – 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 – Head of household did not voluntarily quit
017 – Voluntary quit of non-head of household
096 – Policy incorrectly applied
166 – Improper Sanction – entire household sanction for non-head of household voluntarily quit
167 – 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 – Eligible person(s) disqualified
020 – Good cause for failure/refusal
021 – Social Security Numbers provided
096 – Policy incorrectly applied

RESOURCES (200)
Liquid Resources
Element 211 – Bank Accounts or Cash on Hand
Nature codes:
003 – Agency failed to follow up on inconsistent or incomplete information
024 – Resource should have been excluded
031 – Incorrect limit applied
074 – Improper denial – resource counted as income
096 – Policy incorrectly applied
Element 212 – Nonrecurring Lump-sum Payment
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

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 – 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 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 – Did not transfer resources
023 – Did not exceed limit
025 – Incorrectly applied resources of non-citizen sponsor
026 – Included resources of a non-household member
030 – Does not exceed prescribed limit
031 – Incorrect limit applied
096 – Policy incorrectly applied
097 – Resource counted as income

RESOURCES (300)
Earned Income
Element 311 – Wages and Salaries
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
032 – Failed to consider or incorrectly considered income of an ineligible member
033 – Rounding used/not used or incorrectly applied
034 – Income from known/processed source included that should not have been
035 – Household unemployed
036 – Conversion to monthly amount not used or incorrectly applied
037 – Averaging not used or incorrectly applied
038 – MRRB household not temporarily over the limit
039 – Employment status changed from unemployed to employed
041 – Change only in amount of earnings
042 – Failed to consider/anticipate month with extra pay date
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
168 – Improper income calculation
169 – Improper calculation – Income included holiday or overtime pay
170 – Improper calculation – Income averaged incorrectly
Element 312 – Self-Employment
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
032 – Failed to consider or incorrectly considered income of an ineligible member
033 – Rounding used/not used or incorrectly applied
034 – Income from known/processed source included that should not have been
035 – Household unemployed
036 – Conversion to monthly amount not used or incorrectly applied
037 – Averaging not used or incorrectly applied
038 – MRRB household not temporarily over the limit
039 – Employment status changed from unemployed to employed
041 – Change only in amount of earnings
042 – Failed to consider/anticipate month with extra pay date
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
168 – Improper income calculation
170 – Improper calculation – Income averaged incorrectly
171 – Income is Self-Employment income – not identified as Self-Employment
Element 313 – Other Earned Income
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
032 – Failed to consider or incorrectly considered income of an ineligible member
033 – Rounding used/not used or incorrectly applied
034 – Income from known/processed source included that should not have been
035 – Household unemployed
036 – Conversion to monthly amount not used or incorrectly applied
037 – Averaging not used or incorrectly applied
038 – MRRB household not temporarily over the limit
039 – Employment status changed from unemployed to employed
041 – Change only in amount of earnings
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied

Deductions
Element 321 – Earned Income Deductions
Nature codes:
043 – Deduction that should have been included was not
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
125 – 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 – Agency failed to follow up on inconsistent or incomplete information
004 – Agency failed to follow up on known and reported impending changes
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 332 – Veterans Benefits
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 333 – SSI and/or State SSI Supplement
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 334 – Unemployment Compensation
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied

Element 335 – Worker's Compensation
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 336 – Other Government Benefits
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 342 – Contributions
Errors in Child Support Payments should not be recorded in this Element. See Element 350.
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 343 – Deemed Income
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 344 – TANF, PA OR GA
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 345 – Educational Grants/Scholarships/Loans
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied

Element 346 – Other Unearned Income
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
Element 350 – Child Support Payments Received from Absent Parent
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
034 – Income from known/processed source included that should not have been
046 – Failed to consider or incorrectly considered reported information
096 – Policy incorrectly applied
111 – Child support payments(s) not considered or incorrectly applied for initial month(s) of eligibility
112 – Retained child support payment(s) not considered or incorrectly applied
127 – Pass through not considered or incorrectly applied
170 – 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 – Deduction that should have been included was not
047 – Failed to consider or incorrectly considered Shelter deductions
051 – Incorrect amount used resulting from a change in residence
053 – Incorrectly prorated
096 – Policy incorrectly applied
Element 364 – Standard Utility Allowance
Nature codes:
043 – Deduction that should have been included was not
048 – Failed to consider or incorrectly considered SUA deductions
050 – Incorrect standard used (Not as a result of a change in household size or move)
051 – Incorrect amount used resulting from a change in residence
052 – Incorrect standard used resulting from a change in household size
053 – Incorrectly prorated
096 – 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 Deductions (includes Exclusions)
Nature codes:
040 – Failed to consider or incorrectly considered Child Support deductions (exclusions)
043 – Deduction (exclusion) that should have been included was not
096 – Policy incorrectly applied
111 – 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 – Deductions excluded that should not have been
064 – Household improperly participating under retrospective budgeting
065 – Household improperly participating under prospective budgeting
096 – Policy incorrectly applied
101 – Simplified reporting household
Element 413 – Application
Nature codes:
059 – Household expedited and should have received postponed verification
066 – Improper denial within 30-day period for missing interview(s)
073 – Improper denial - failed to screen for expedited service
076 – Failed to provide expedited service to expedited eligible household
077 – Failed to issue a required Notice of Missed Interview (NOMI)
078 – Denial before the 30th day
079 – Incorrect use of allotment tables
081 – Late denial agency failed to process the application timely
082 – Improper denial for missing interview when interview never scheduled
096 – Policy incorrectly applied
117 – 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 – Agency failed to follow up on inconsistent or incomplete information
004 – Agency failed to follow up on known and reported impending changes
056 – Improper Denial/Termination – failure to provide – verification was received or was in case file
069 – Improper denial prior to end of timeframe for providing verification
080 – No application or case record information to support denial/termination/suspension
096 – Policy incorrectly applied
102 – Verification of income requested for a person not associated with current application
103 – Verification of resources requested for a person not associated with current application
105 – Verification was in case file
172 – Improper Denial/Termination – failure to provide – case should have been processed without the deduction
173 – Improper Denial/Termination – failure to provide – categorically eligible household with deemed eligibility elements
174 – Improper Denial/Termination – failure to provide – failed to send a request for contact
175 – Improper Denial/Termination – failure to provide – verification requested was for another program
176 – Improper Denial/Termination – failure to provide – household never notified of needed verification
177 – Improper Denial/Termination – failure to provide – household not given at least 10 days to provide
178 – Improper Denial/Termination – failure to provide – prior to the 30th day
Element 416 – Action Type
Nature codes:
070 – Improper denial or termination when the case should have been suspended
071 – Improper suspension when the case should have been denied or terminated
072 – Improper termination or suspension for failure to meet reporting requirements
096 – Policy incorrectly applied
Element 511 – Other
Nature codes:
005 – Computer programming error
012 – Computer user error (improper use of system or unauthorized process or work around)
013 – Data entry and/or coding error (includes selection of incorrect codes)
055 – Failure to provide verification for a period of time not associated with current application
084 – Information reported by a bank or financial institution contact inaccurate
085 – Information reported by a collateral contact inaccurate
086 – Information reported by an employer contact inaccurate
087 – Information reported by a landlord contact inaccurate
095 – Other public assistance case was terminated / denied
096 – Policy incorrectly applied
099 – 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 – Failed to send notice of action
089 – Notice did not include date of intended action
090 – Notice did not include rights of household
091 – Notice not clearly understandable
092 – Notice reason does not match reason for action
093 – Notice was not complete
094 – Notice was sent to wrong address
096 – 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.

19.

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 not clear and
accurate.
03 – Telephone contact made to the household – information in case record regarding an element(s) was not clear and
accurate.
04 – Letter contact made to a collateral source – information in case record regarding an element(s) was not clear and accurate.
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) was not clear and accurate.
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 not clear and
accurate.
07 – Face-to-face contact made to the household – information in case record regarding an element(s) was not clear and
accurate

20.

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

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?
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 clearly understandable and specific about what was happening?