A FNA 380-1 OMB 0584-0299 Form and Instructions 9-18-2026

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OMB APPROVED NO. 0584-0299
Expiration Date: 00''<<<<

U.S. Department of Agriculture - )RRGDQG1XWULWLRQ$GPLQLVWUDWLRQ

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QUALITY CONTROL REVIEW SCHEDULE

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This information is being collected to assist the )RRGDQG1XWULWLRQ$GPLQLVWUDWLRQ with the Supplemental Nutrition Assistance Program's Quality Control Reviews. This is a
mandatory collection and )1$ uses the information for program monitoring, evaluation, corrective action, and characteristics. This collection does request personally identifiable
information under the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0584-0299. The time required to complete this
information collection is estimated to average 1.056 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. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: U.S. Department of Agriculture, )RRGDQG1XWULWLRQ$GPLQLVWUDWLRQ, 3ODQQLQJDQG5HJXODWRU\$IIDLUV2IILFH6XQQ\VLGH$YH
%OGJ)/%HOWVYLOOH0' ATTN: PRA (0584-0299). Do not return the completed form to this address. PRIVACY ACT NOTICE: This report is required under provisions of 7
CFR 275.24 (SNAP). This information is needed for the review of State performance in determining recipient eligibility. The information is used to determine State compliance, and
failure to report may result in a finding of non-compliance.

2. Case Number

3. State

4. Local Agency

or

7. Disposition

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1. QC Review Number

Section 1 - Review Summary

8. Findings

9. SNAP Allotment Under Review

5. Sample Month and Year

10. Error Amount

6. Stratum

11. Case Classification

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Section 2 - Detailed Error Findings
13. Nature

14. Cause

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FORM )1$-380-1 (00<<<<) Previous Editions Obsolete

b. Time Period

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19. Occurrence
a. Date

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18. Verified

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17. Discovery

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16. Error Amount

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15. Error Finding

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12. Element

(OHFWURQLF)RUP'HVLJQHGLQ$GREH3UR9HUVLRQ

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20. Most Recent Cert. Action
Month, Day, Year

21. Type of Action

22. Length of Cert. Period
#of months

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25. Number of
Household Members

Section 3 - Household Characteristics

26. Receipt of
Expedited Service

27. Authorized Representative
Used at Application

23. Allotment Adjustment

24. Amount of
Allotment Adjustment

28. Categorical Eligibility

29. Reporting Requirement

or

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Resources:
30. Liquid

34. Other Non-liquid

43. Rent/Mortgage

44. Use of SUA
a. Usage
b. Proration

40. Child Support

41. Shelter

42. Homeless

45. Utilities (SUA or Actual)

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39. Dependent Care

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38. Medical

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Additional
Information on
Shelter Costs:

33. Countable
Vehicle Assets

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36. Net

Deductions:
37. Earned Income

32b. Status
2nd Vehicle

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Income:
35. Gross

32a. Vehicle

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31. Property
(excluding home)

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Section 4 - Information on Each Household Member

46. Person
Number

48. RelationWR 49. Age
47. SNAP
Participation +HDGRI++

50.Sex

51.Race

53. Edu.
Level

 &LWL]HQ
Status

54. Employment
Status
Hours

55. SNAP
Work Reg.

56. SNAP
E&T

57. 7LPH
58. Dependent
/LPLWHG
Care Cost
3DUWStatus

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Section 5 - Income Identified by Household Member

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59. Person
Number

Source 1
60. Income Type

61. Amount

Source 2
62. Income Type

63. Amount

Source 3
64. Income Type

65. Amount

LQGLYLGXDOVPD[
Source 4
66. Income Type

67. Amount

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Section 6 - Reserved Coding
70.Recert
Timeliness

71.Allotment
Test

72. Household
Zip code

73.+RXVHKROG
,QWHUYLHZ

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68. Application 69.QC
Proc.Timeliness Interview

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2.

4.

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3.

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3URMHFW 6HUYLFHPHPEHU

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Section 7 - Optional For State Use

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INSTRUCTIONS FOR COMPLETING FORM FNA 380-1,
QUALITY CONTROL REVIEW SCHEDULE

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GENERAL INFORMATION

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The Quality Control Review Schedule (QCRS) is the data entry form to record the results of SNAP
Quality Control reviews.
The schedule consists of seven sections:

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1 - Review Summary
2 - Detailed Error Findings
3 - Household Characteristics
4 - Information on Each Household Member
5 - Income Identified by Household Member
6 - Reserved Coding
7 - Optional - For State Systems Only

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All entries in the QCRS are dollar amounts, dates, or numeric codes.

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Dates - Use six or eight-digit
g
g numbers as the entry requires. For example, October 3, 2003, would be
coded: 1 0 0 3 2 0 0 3
The October sample month would be coded: 1 0 2 0 0 3

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Dollar Amounts - Round all dollar amounts to the nearest dollar; leading zeros are not required. For
example, $165.00 is entered: 0 1 6 5
Not Applicable
- If an item does not apply to the case reviewed, leave the applicable boxes blank:
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Unknown - If an item is known to exist but the specific amount is not known, fill in all boxes for that
item with 9's: 9 9 9 9

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

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

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Local Agency Code - States must assign each SNAP local office and any call center unit with the
ability to make eligibility determinations or redeterminations, a unique three-digit local agency code
(LAC). The system requires a three-digit code.

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The State may use Federal Information Processing Standards (FIPS) codes or use an alternative
method to designate the local agency code. Once a State has selected a method, the State must
submit to FNA a listing of the local agencies and call center units and corresponding codes.
*Any updates to the LAC codes require a resubmission of the listing to FNA with the updates
identified.

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FIPS Codes - The National Institute of Standards and Technology has developed codes for

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classification of counties and county equivalents. These codes were devised by listing counties
alphabetically and assigning sequentially odd integers, e.g., 001, 003, 005.

QUALITY CONTROL REVIEW SCHEDULE

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SECTION 1 - REVIEW SUMMARY

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This section records the final determination of the QC review. It is used to compute the States
payment error rate.

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

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

Standards and Technology.

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

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State Codes - National Institute of Standards and Technology
State

Code

Alabama

01

Montana

30

Alaska

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02

Nebraska

31

Arizona

04

Nevada

32

Arkansas

05

New Hampshire

33

California

06

New Jersey

34

Colorado

08

New Mexico

35

09

New York

36

10

North Carolina

37

District of Columbia

11

North Dakota

38

Florida

12

Ohio

39

13

Oklahoma

40

Oregon

41

Pennsylvania

42

Rhode Island

44

South Carolina

45

South Dakota

46

Tennessee

47

Texas

48

Utah

49

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Code

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State

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Connecticut

Georgia

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Delaware

Hawaii

15

Idaho

16

Illinois

17

Indiana

18

Iowa

19

Kansas

20

Kentucky

21

Louisiana

22

Vermont

Maine

23

Virgin Islands

Maryland

24

Virginia

Massachusetts

25

Washington

Michigan

26

West Virginia

54

Minnesota

27

Wisconsin

55

Mississippi

28

Wyoming

56

Missouri

29

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Guam

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50

78

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51

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53

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4. Local Agency Code – Enter the three-digit numeric LAC that represents the SNAP local office or
call center unit that finalized the most recent certification action.

level were reviewed.

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5. Sample Month and Year - Enter the month and year for which the case eligibility and benefit

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

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7. Disposition - Enter one of the following codes:
0-

Case deselected

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Complete

2-

Incomplete

345-

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1-

Not subject to review – Non-participation
Not subject to review – Pending a hearing
Not subject to review – Under active investigation

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Not subject to review – Oversampling

7-

Not subject to review – Case Listed in Error

8-

Not subject to review – Disaster Case

9-

Not subject to review – Unable to Interview or Moved out of State or All
Household Members Have Died

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If codes 0,2 through 9 are used, reviewers must enter codes for item 9 in Section 1, 20-29 in
Section 3, 46-53 in Section 4, and 68 and 70, in Section 6. For these cases, reviewers will use
information from the case record to complete the items.

1 - Amount correct

3 - Underissuance

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2 - Overissuance

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8. Review Findings - Enter one of the following codes:

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4 - Ineligible for not meeting conditions of eligibility (gross/net income tests, resources,
citizenship, ineligible ABAWD, etc.)

6 Ineligible- over income

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5 - Ineligible for non-compliance with a required process for issuing or continuing benefits
[household never submitted an application, household participating with an expired
certification, or household never submitted (or submitted an incomplete) mandatory
report form]

Enter actual finding regardless of whether it is below the error threshold. Do not complete
sections 4 and 5 if case is determined ineligible (codes 4 or 5 are used here).
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9. SNAP Allotment Under Review - Enter the authorized dollar amount of SNAP allotment subject
to review for the sample month.

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

For overissuance or underissuance errors, enter the actual error amount whether
or not it exceeds the QC error tolerance threshold.

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·

For ineligible errors, enter the allotment under review to reflect the total amount
sampled is an error.

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11. Case Classification - Enter one of the following codes:
1 - Included in error rate calculation.

2 - Excluded from error rate calculation, as designated by FNA (e.g. demo project).

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SECTION 2 - DETAILED ERROR FINDINGS

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When a variance or variances exist for the final error determination, this section provides for the
detailed coding of each variance identified during the QC review. If additional lines are needed to
code error findings, attach an additional page. Since the information recorded in this section is the
basis for corrective actions, the accuracy of the information is important. If more than one variance is
identified, the variance that the agency believes is most significant in leading to the error should be
listed first.

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

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13. Nature codes - Enter the appropriate code for the nature of each variance.

The following provides the element and nature codes to be used in items 12 and 13.

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Nature code (98) - Transcription or computation errors.

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These nature codes may be used in any element:

Nature code (99) - Use this nature code when 98, or none of the listed nature codes under
an element apply to the error being recorded.

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BASIC PROGRAM REQUIREMENTS - (100)

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ELEMENT 111 - STUDENT STATUS
Nature codes:

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6 - Eligible person(s) excluded
7 - Ineligible person(s) included

ELEMENT 130 - CITIZENSHIP AND NON-CITIZEN STATUS

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Nature codes:

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Citizens

7-

Eligible person(s) excluded

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6-

Ineligible person(s) included

124 - Variance resulting from use of automatic Federal information exchange system
Non-Citizens

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200 - Eligible non-citizen excluded

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201 - Ineligible non-citizen included

124 - Variance resulting from use of automatic Federal information exchange system

99 – Other

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ELEMENT 150 - HOUSEHOLD COMPOSITION

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Nature codes:

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ELEMENT 140 - RESIDENCY

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

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For example: the discovery of an unreported 62-year-old with earned income, a bank account,
and medical expenses would be recorded under Element 150 (Household Composition), not
Elements 211 (Bank Accounts or Cash on Hand), 311 (Wages and Salaries), and 365 (Medical
Deduction).

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Variances should not be coded under this Element for persons with characteristics that are
specifically addressed under other 100 Series Elements (Student Status through Social
Security Number). For example: the discovery of an eligible non-citizen in the household who
was improperly excluded would be coded under Element 130 (Citizenship and Non-Citizen
Status), not under Element 150 (Household Composition).
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Nature codes:
7 - Ineligible person(s) included
12 - Eligible person(s) with no income, resources, or deductible expenses excluded

14 - Eligible person(s) with resources excluded

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13 - Eligible person(s) with income excluded

15 - Eligible person(s) with deductible expenses excluded
16 - Newborn infant improperly excluded

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ELEMENT 151 - RECIPIENT DISQUALIFICATION

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Nature codes:

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6 - Eligible person(s) excluded
7 - Ineligible person(s) included

ELEMENT 160 - EMPLOYMENT & TRAINING PROGRAMS

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Nature codes:

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6 - Eligible person(s) excluded

7 - Ineligible person(s) included

B

Nature codes:
6 - Eligible person(s) excluded
7 - Ineligible person(s) included

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ELEMENT 161 - TIME-LIMITED PARTICIPATION

6 - Eligible person(s) excluded

ELEMENT 163 - VOLUNTARY QUIT/REDUCED WORK EFFORT

6 - Eligible person(s) excluded
7 - Ineligible person(s) included

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Nature codes:

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7 - Ineligible person(s) included

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Nature codes:

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ELEMENT 162 - WORK REGISTRATION REQUIREMENTS

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ELEMENT 164 - WORKFARE AND COMPARABLE WORKFARE
Nature codes:
6 - Eligible person(s) excluded

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7 - Ineligible person(s) included

ELEMENT 165 - EMPLOYMENT STATUS/JOB AVAILABILITY

Nature codes:

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6 - Eligible person(s) excluded
7 - Ineligible person(s) included

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Nature codes:

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ELEMENT 166 - ACCEPTANCE OF EMPLOYMENT

6 - Eligible person(s) excluded
7 - Ineligible person(s) included

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Nature codes:

B

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ELEMENT 170 - SOCIAL SECURITY NUMBER

6 - Eligible person(s) excluded

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7 - Ineligible person(s) included

RESOURCES - (200)

Nature codes:

30 - Resource should have been included

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24 - Resource should have been excluded

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Liquid Resources
ELEMENT 211 - BANK ACCOUNTS OR CASH ON HAND

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ELEMENT 212 - NONRECURRING LUMP-SUM PAYMENT (INCLUDES NON-SUBSTANTIAL LOTTERY OR
GAMBLING WINNINGS)

24 - Resource should have been excluded
30 - Resource should have been included

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Nature codes:

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ELEMENT 213 - OTHER LIQUID ASSETS
Nature codes:
24 - Resource should have been excluded

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30 - Resource should have been included

ELEMENT 214 – SUBSTANTIAL LOTTERY OR GAMBLING WINNINGS
Nature codes:

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29 – Exceeds prescribed limit

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Nature codes:

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Non-Liquid Resources
ELEMENT 221 - REAL PROPERTY

24 - Resource should have been excluded
30 - Resource should have been included

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Nature codes:

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ELEMENT 222 - VEHICLES

24 - Resource should have been excluded

ELEMENT 224 - OTHER NON-LIQUID RESOURCES

24 - Resource should have been excluded

Nature codes:

29 - Exceeds prescribed limit

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20 - Incorrect resource limit applied

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ELEMENT 225 - COMBINED RESOURCES

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30 - Resource should have been included

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Nature codes:

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30 - Resource should have been included

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INCOME (300)

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Earned Income

ELEMENT 311 - WAGES AND SALARIES

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Nature codes:

32 - Failed to consider or incorrectly considered income of an ineligible member
33 - Failed to consider the income of an eligible member

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35- Unreported source of income (do not use for change in employment status)

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36- Rounding used/not used or incorrectly applied

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37- All income from source was known but not included
38- More income was received from this source than budgeted
39- Employment status changed from unemployed to employed
40- Employment status changed from employed to unemployed

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41- Change only in amount of earnings

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42- Conversion to monthly amount not used or incorrectly applied

B

43- Averaging not used or incorrectly applied
44- Less income received from this source than budgeted

ELEMENT 312 - SELF-EMPLOYMENT

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46 - Failed to consider/anticipate month with extra pay date
123 - Income incorrectly prorated

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Nature codes:

32 - Failed to consider or incorrectly considered income of an ineligible member

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33 - Failed to consider the income of an eligible member

36 - Rounding used/not used or incorrectly applied
38 - More income received from this source than budgeted

40 - Employment status changed from employed to unemployed
41 - Change only in amount of earnings
42 - Conversion to monthly amount not used or incorrectly applied

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39 - Employment status changed from unemployed to employed

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35 - Unreported source of income (do not use for change in employment status)

43 - Averaging not used or incorrectly applied
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44 - Less income received from this source than budgeted
45 - Cost of doing business not used or incorrectly applied

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ELEMENT 314 - OTHER EARNED INCOME

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Nature codes:

32 - Failed to consider or incorrectly considered income of an ineligible member
33 - Failed to consider the income of an eligible member

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35 - Unreported source of income (do not use for change in employment status)
36 - Rounding used/not used or incorrectly applied

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38 - More income received from this source than budgeted

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39 - Employment status changed from unemployed to employed
40 - Employment status changed from employed to unemployed
41 - Change only in amount of earnings
42 - Conversion to monthly amount not used or incorrectly applied

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43 - Averaging not used or incorrectly applied

M

44 - Less income received from this source than budgeted
45 - Cost of doing business not used or incorrectly applied

B
ELEMENT 321 - EARNED INCOME DEDUCTIONS
Nature codes:

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Deductions

52 - Deduction that should have been included was not

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53 - Deduction included that should not have been

56 - Incorrect deduction amount included-budgeted too much

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57 - Incorrect deduction amount included-budgeted too little

Nature codes:
52 - Deduction that should have been included was not

56 - Incorrect deduction amount included-budgeted too much
57 - Incorrect deduction amount included-budgeted too little

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53 - Deduction included that should not have been

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ELEMENT 323 - DEPENDENT CARE DEDUCTION

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UNEARNED INCOME
ELEMENT 331 - RSDI BENEFITS
Nature codes:

35 - Unreported source of income

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33 - Failed to consider the income of an eligible member

37 - All income from source was known but not included
38 - More income received from this source than budgeted

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44 - Less income received from this source than budgeted
58 - Income should have been excluded (no other coding option applies)

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124 - Variance resulting from use of automatic Federal information exchange system

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ELEMENT 332 - VETERANS BENEFITS
Nature codes:

35 - Unreported source of income

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37 - All income from source was known but not included

M

38 - More income received from this source than budgeted
44 - Less income received from this source than budgeted

B

124 - Variance resulting from use of automatic Federal information exchange system

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ELEMENT 333 - SSI AND/OR STATE SSI SUPPLEMENT
Nature codes:

33 - Failed to consider the income of an eligible member

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35 - Unreported source of income

37 - All income from source was known but not included

44 - Less income received from this source than budgeted

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38 - More income received from this source than budgeted

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58 - Income should have been excluded (no other coding option applies)

124 -Variance resulting from use of automatic Federal information exchange system

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ELEMENT 334 - UNEMPLOYMENT COMPENSATION
Nature codes:

35 - Unreported source of income

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33 - Failed to consider the income of an eligible member

37 - All income from source was known but not included
38 - More income received from this source than budgeted

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44 - Less income received from this source than budgeted
58 - Income should have been excluded (no other coding option applies)

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124 - Variance resulting from use of automatic Federal information exchange system

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ELEMENT 335 - WORKER'S COMPENSATION
Nature codes:

33 - Failed to consider the income of an eligible member

O

35 - Unreported source of income

M

37 - All income from source was known but not included
38 - More income received from this source than budgeted

B

44 - Less income received from this source than budgeted

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58 - Income should have been excluded (no other coding option applies)
124 - Variance resulting from use of automatic Federal information exchange system

ELEMENT 336 - OTHER GOVERNMENT BENEFITS

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Nature codes:

33 - Failed to consider the income of an eligible member

37 - All income from source was known but not included

44 - Less income received from this source than budgeted

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38 - More income received from this source than budgeted

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35 - Unreported source of income

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58 - Income should have been excluded (no other coding option applies)

124 - Variance resulting from use of automatic Federal information exchange system

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OTHER INCOME
ELEMENT 342 - CONTRIBUTIONS

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Note: Errors in Child Support Payments should not be recorded in this Element. See Element
350 (Child Support Payments Received from Absent Parent).

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Nature codes:

35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted

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44 - Less income received from this source than budgeted

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58 - Income should have been excluded (no other coding option applies)

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124 - Variance resulting from use of automatic Federal information exchange system

ELEMENT 343 - DEEMED INCOME
Nature codes:

O

35 - Unreported source of income

M

37 - All income from source was known but not included
38 - More income received from this source than budgeted

B

44 - Less income received from this source than budgeted
124 - Variance resulting from use of automatic Federal information exchange system

Nature codes:

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35 - Unreported source of income

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ELEMENT 344 - TANF, PA, OR GA

37 - All income from source was known but not included

44 - Less income received from this source than budgeted

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38 - More income received from this source than budgeted

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58 - Income should have been excluded (no other coding option applies)

120 - Variance/errors resulting from noncompliance with this means-tested public
assistance program

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124 - Variance resulting from use of automatic Federal information exchange system

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ELEMENT 345 - EDUCATIONAL GRANTS/SCHOLARSHIPS/LOANS
Nature codes:
35 - Unknown source of income

38 - More income received from this source than budgeted

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37 - All income from source was known but not included

44 - Less income received from this source than budgeted
58 - Income should have been excluded (no other coding option applies)

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124 - Variance resulting from use of automatic Federal information exchange system

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ELEMENT 346 - OTHER UNEARNED INCOME

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Nature codes:

35 - Unreported source of income
37 - All income from source was known but not included
38 - More income received from this source than budgeted

O

44 - Less income received from this source than budgeted

M

58 - Income should have been excluded (no other coding option applies)
120 - Variance/errors resulting from noncompliance with this means-tested public

B

assistance program

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124 - Variance resulting from use of automatic Federal information exchange system

ELEMENT 350 - CHILD SUPPORT PAYMENTS RECEIVED FROM ABSENT PARENT
Nature codes:

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35 - Unreported source of income

37 - All income from source was known but not included

44 - Less income received from this source than budgeted

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38 - More income received from this source than budgeted

2
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111- Child support payment(s) not considered or incorrectly applied for initial month(s) of
eligibility

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112 - Retained child support payment(s) not considered or incorrectly applied

124 - Variance resulting from use of automatic Federal information exchange system
127 - Pass through not considered or incorrectly applied

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MORE DEDUCTIONS
ELEMENT 361 - STANDARD DEDUCTION
Nature codes:

53 - Deduction included that should not have been

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52 - Deduction that should have been included was not

54 - Incorrect standard used (not as a result of a change in household size or move)
65 - Incorrect standard used resulting from a change in household size

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ELEMENT 362 – HOMELESS SHELTER DEDUCTION

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Nature codes:

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51- Actual expenses exceeded standard; household opted for use of actual
52 - Deduction that should have been included was not
53 - Deduction included that should not have been

O

ELEMENT 363 - SHELTER DEDUCTION

M

Nature codes:

52 - Deduction that should have been included was not

B

53 - Deduction included that should not have been

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56 - Incorrect deduction amount included-budgeted too much
57 - Incorrect deduction amount included-budgeted too little

64 - Incorrect amount used resulting from a change in residence

Nature codes:

52 - Deduction that should have been included was not
53 - Deduction included that should not have been

al

ov

ELEMENT 364 - STANDARD UTILITY ALLOWANCE

2
9-

54 - Incorrect standard used (Not as a result of a change in household size or move)
64 - Incorrect amount used resulting from a change in residence

6
02

123 - Incorrectly prorated

16

ELEMENT 365 - MEDICAL DEDUCTIONS
Nature codes:

52 - Deduction that should have been included was not

ffi
no

U

51- Actual expenses exceeded standard; household opted for us of actual

53 - Deduction included that should not have been
56 - Incorrect deduction amount included-budgeted too much

ci

57- Incorrect deduction amount included-budgeted too little

al

ELEMENT 366 - CHILD SUPPORT PAYMENT DEDUCTION

or
-f

Nature codes:

52 - Deduction that should have been included was not
53 - Deduction included that should not have been
56 - Incorrect deduction amount included-budgeted too much

O

57 - Incorrect deduction amount included-budgeted too little

M

INCOME ELIGIBLITY TESTS
Nature codes:

B

ELEMENT 371 - COMBINED GROSS INCOME

29 - Exceeds prescribed limit

Nature codes:

29 - Exceeds prescribed limit

Nature codes:
75 - Benefit/allotment/eligibility incorrectly computed
79 - Incorrect use of allotment tables

6
02

ELEMENT 520 - ARITHMETIC COMPUTATION

2
9-

OTHER - (500 and 800)

al

28 - Incorrect income limit applied

ov

ELEMENT 372 - COMBINED NET INCOME

pr
ap

28 - Incorrect income limit applied

80 - Improper proration of initial month's benefits
17

ELEMENT 530 - TRANSITIONAL BENEFITS
Nature codes:

77 - Household not entitled to transitional benefits

ffi
no

U

75 - Benefit/allotment/eligibility incorrectly computed

ELEMENT 540 – MISSING REPORTS

ci

Nature codes:

310 - Household did not return report

al

312 - Household returned incomplete report

or
-f

ELEMENT 542 – EXPIRED CERTIFICATION PERIOD
Nature codes:

314 - Household receiving benefits without proper recertification

M

O

ELEMENT 560 - REPORTING SYSTEMS

B

Note: This element should be used to record errors resulting from the household being
certified under an incorrect reporting system given the household's characteristics and the
State agency's chosen options. Possible Reporting Systems include: Monthly Reporting,
Quarterly Reporting, Simplified Reporting, Change Reporting, and transitional benefits.

pr
ap

Nature codes:

303 - Household improperly participating under Monthly Reporting
304 - Household improperly participating under Quarterly Reporting

ov

305 - Household improperly participating under Simplified Reporting
306 - Household improperly participating under Change Reporting

al

309 - Household improperly participating under Transitional benefits

Nature codes:

ELEMENT 820 - DEMONSTRATION PROJECTS
Nature codes:

6
02

98 - Transcription or computation errors

2
9-

ELEMENT 810 - SNAP SIMPLIFICATION PROJECT

98 - Transcription or computation errors
18

14. Cause - Enter one of the following codes to indicate the primary cause for each variance
identified.

ffi
no

U

1- Information not reported (Client failed to report information or changes that are
required to be reported. Use this code only if the State could not know this
information from another source or could not have anticipated the change.)
2- Incomplete or incorrect information provided (Client provided information that is
incorrect or incomplete and the agency was not required to verify.)
3- Information withheld by client (Case being referred for IPV investigation.)

ci

4- Incorrect information provided by client (Case being referred for IPV investigation.)

al

or
-f

7- Information reported by a collateral contact inaccurate (The agency acted upon
information provided by a collateral contact, which was verified by QC to be
inaccurate, i.e. the client's employer reported incorrect salary information.)
8- Acted on incorrect Federal computer match information that was not required to be
verified (This variance is excluded from the error determination but must be
recorded.)

O

M

10- Policy incorrectly applied (The agency used the wrong policy/incorrectly applied
policy when determining eligibility or processing change information.)

B

11- Policy incorrectly applied- (The agency did not implement a mandatory program
change on time)

pr
ap

12- Reported information disregarded or not applied (The agency failed to take action on
information reported by the client or information that became known through some
other source, such as non-federal match information.)

ov

14- Agency failed to follow up on inconsistent or incomplete information (Information
provided by the household or collateral source was inconsistent with other
information in the case record or incomplete but the agency failed to request
verification.)

al

15- Agency failed to follow up on impending changes (The agency failed to take followup action on a change that was anticipated, i.e. unemployment ending within the
certification period, pregnancy, etc.)

2
9-

6
02

16- Agency failed to verify required information (The agency failed to use third party
information or documentation to establish the accuracy of statements on the
application or change report form which are required to be verified. If the agency is
not required to verify reported information use code 2.)

17- Computer programming error (The agency eligibility system caused the error due to
a programming related problem, i.e. an incorrect amount for standard deduction was
programmed into the system, the agency authorized the use of workarounds to the
computer system that resulted in an error, etc.)
19

18- Data entry and/or coding error (The agency made a data entry error when keying
into the State/local agency eligibility system, including selection of incorrect codes.)

20- Arithmetic computation (The agency made an error in computation or transcription,
which was not related to computer programming or data entry.)

ffi
no

U

19- Mass Change (The error was due to a problem with a computer-generated mass
change, i.e. mass change was run late or incorrectly updated the case.)

21- Computer user error (The EW failed to use computer system properly or used an
unauthorized process to work around the system.)

ci

al

22- Agency budgeted an incorrect amount (Not a transposing or arithmetic error, agency
budgeted incorrectly)
23- Agency failed to follow recertification procedure related to notices/forms

or
-f

24- Agency failed to follow recertification procedure related to interviews
25- Agency failed to follow recertification procedure related to timeframes

O

26- Other. (No other cause code applicable)

B

M

99 - Other. (Variance caused by the agency, which does not fall under any of the specific
causes listed above.)

15. Error Finding – This item provides a means for reviewers to identify the impact of individual

1- Overissuance
2- Underissuance

ov

3- Ineligible- Over-income

pr
ap

variances. If only one variance is recorded for an error case, the error finding code for this item
and item 8, finding, should be the same. Enter the appropriate code for each variance:

16. Error Amount - Compute and enter the dollar amount of each separate variance. If one

al

variance is coded, then the amount in this item should be the same as the error amount in item
10. If more than one variance is coded, the agency may use the optional guidance provided in
Chapter 12 or use State developed procedures for assigning dollar amounts. Some agencies find
this calculation helpful as an aid in prioritizing error causes for corrective actions.

2
9-

6
02
20

17. Discovery - Enter one of the following codes to indicate how the variance was discovered:

ffi
no

U

1 - Variance clearly identified from case record: documentation is not from an automated
match
2 - Variance clearly identified from case record: documentation is from an automated match
3 - Variance discovered from recipient interview
4 - Employer (present or former)

ci

5 - Financial institution, insurance company, or other business

al

6 - Landlord

or
-f

7 - Government agency or public records, not automated match
8 - Government agency or public records, automated match
9 - Other

M

O

18. Verified - Enter one of the following codes to indicate how the variance was verified:
1 - From case record: verification is not from an automated match

B

2 - From case record: verification is from an automated match
3 - From information provided by recipient

pr
ap

4 - Employer (present or former)

5 - Financial institution, insurance company, or other business
6 - Landlord

ov

7 - Government agency or public records, not automated match

9 - Other

al

8 - Government agency or public records, automated match (may not apply to tax
information)

2
9-

6
02
21

19. Occurrence - Complete the following for each variance:
a. Date - Enter the date (month and year) the variance occurred.
variance occurred.

ffi
no

U

b. Time Period - Enter the appropriate code to indicate the time period during which the
1 - Before most recent action by agency (The most recent action would be either a
certification or a recertification.)
2 - At time of most recent action by agency

ci

3 - After the most recent action by agency

or
-f

al

9 - Time of occurrence cannot be determined

SECTION 3 - HOUSEHOLD CHARACTERISTICS

This section collects information about the household's processing and specifics about resources,
income, and deductions that were the basis of their SNAP benefits.

M

O

Some specific items come from the case record (Items 20-24, and 26-27). These items are: most
recent action, type of action, length of certification period, allotment adjustment, amount of
adjustment, receipt of expedited service, and authorized representative.
For all other items use information from the final QC determination.

B

20. Most Recent Certification Action - Enter the effective date (month, day and year) of the most

pr
ap

recent certification or recertification action prior to or concurrent with the review date. This date
cannot be prior to the start of the most recent certification period and should be in the case
record.

entering one of the following codes:

2 - Recertification

al

1 - Certification

ov

21. Type of Action - Based on information in the case record, indicate the type of action by

2
9-

Certification means the first time a case has been certified or a certification action following a
break in participation.

6
02

Recertification means the initial certification period has expired and the agency has (a)
completed a re-examination of all factors of eligibility subject to change following a period
during which the recipient has been determined eligible and (b) decided to continue eligibility.

22

22. Length of Certification Period - Enter the number of months the household was certified to

participate during the current certification or recertification. For households that are participating
in months for which they have not been certified enter the code 98. This information should be
found in the case record.

ffi
no

U

23. Allotment Adjustment - This item records whether there was any adjustment from the

ci

standard amount for the household size and income level of the household. Proration is providing
less than a full month's allotment due to the date of application or receipt of verification. Other
adjustments include claims recoupment, sanctions, and adjustments for failure to comply with
other means tested programs. Supplements included in the allotment are not considered as
allotment adjustments for this item.

or
-f

al

Enter the code that indicates whether the allotment was adjusted or prorated. If more than one
adjustment was made, enter the code for the adjustment with the greatest impact on the SNAP
allotment. Supplements included in the allotment are not considered as allotment adjustments for
this item.
1 - No adjustment

2 - Prorated benefit

3 - Other adjustment

O

24. Amount of Allotment Adjustment - Enter the amount of the allotment adjustment from the

B

M

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

pr
ap

25. Number of Household Members - Enter the number of person(s) determined to be a part of

al

ov

the SNAP household and eligible to receive benefits based on the final QC determination.
Include persons who should have been in the household but were not in the State's original
determination. Do not include persons whose income/resources are considered but are not
receiving SNAP benefits or SNAP household members who have been disqualified from the
program. If the household was ineligible for benefits, enter zero.

26. Receipt of Expedited Service - Expedited service for initial applications requires that

2
9-

participants who are entitled based on their income and/or resources have the opportunity to
participate within 7 days from the date of application.

Using information from the case record, enter the appropriate code for the household's
entitlement to expedited service at the most recent certification in effect at the time of the sample
month:

6
02

1 - Entitled to expedited service and received benefits within the Federal timeframe.

2 - Entitled to expedited service but did not receive benefits within the Federal timeframe.
3 - Not entitled to expedited service.
4 - Not applicable- recertification action
23

27. Authorized Representative Used at Application - Enter the appropriate code using

1 - Yes

ffi
no

U

information from the case record. An authorized representative is a responsible adult designated
by the household, in writing, to apply for benefits on behalf of the household. Did an authorized
representative make application for the household?

2 - No

ci

28. Categorical Eligibility Status - Was the household categorically eligible for benefits based on
the final QC determination?

or
-f

al

1 - Yes, traditional categorical eligibility conferred through SSI, TANF cash assistance, or
general assistance (GA)
2 - Yes, categorical eligibility (including BBCE) conferred through any non-cash or in-kind
TANF/MOE benefit
3 - No

O

29. Reporting Requirement - Select the code that describes the reporting system used to certify

1- Change Reporting

B

M

the household. If the household was certified under six-month reporting, enter code “3” or “4”,
simplified reporting (also called six-month reporting or semiannual reporting), even if QC
determined that the appropriate reporting system should have been something else.

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ap

3 - Simplified Reporting (no periodic report required)
4 - Simplified Reporting (periodic report required)
5 - Quarterly Reporting
6 - Monthly Reporting

9 - Other

al

Resources:

ov

7 - Transitional benefits

2
9-

30. Liquid Assets - Enter the dollar value of liquid assets such as cash on hand, checking and

6
02

savings accounts, money market accounts, stocks, bonds, income tax refunds using information
from the final QC determination. For amounts greater than $99,998 enter the code 99998. When
there is an indication that a resource type was present but that amount is unknown, enter the
code 99999. If an approximate amount is known, enter that amount.

24

31. Real Property (Excluding Home) - Enter the dollar value of land and buildings owned,

ffi
no

U

excluding the primary residence using information from the final QC determination. For amounts
greater than $99,998 enter the code 99998. When there is an indication that a resource type
was present, but that amount is unknown, enter the code 99999. If an approximate amount is
known, enter that amount.

32(a). Vehicle - Code information on up to two vehicles in items (a) and (b). Use information from

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the final QC determination. Vehicles should be entered in descending order based on the
fair market value.

al
1 - No vehicles

or
-f

2 - Vehicle exempt because used for producing income, as a home, to transport a
physically disabled member, for long distance travel (other than commuting), or to
carry fuel or water.

3 - Vehicle exempt because inaccessible resource (equity value is $1,500 or less)
4 - Vehicle exempt due to categorical eligibility

O

M

5 - Vehicle excluded under State TANF standard (vehicle of non-categorically eligible
household members only)

B

6 - Vehicle is registered and is attributable to an adult household member or is used by
a person under 18 for employment or education (subject to fair market value only)
7 - Vehicle not registered (equity test only)

pr
ap

8 - Vehicle is not excluded and is not included in code 6 (subject to fair market value or
equity test, whichever is greater)

32(b). Status 2nd Vehicle - Use codes 1 through 8 from 32(a).

ov

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

al

34. Other Non-liquid Assets - Enter the dollar value of non-liquid assets such as boats and

2
9-

trailers using information from the final QC determination. For known amounts less than $99,998
enter the amount. For amounts greater than $99,998 enter 99998. When there is an indication a
resource type was present, but the amount is unknown, enter 99999. If an approximate amount
is known, enter that amount.

6
02
25

Income:

35. Gross Countable Income - Enter the countable gross monthly income of the SNAP

ffi
no

U

household before applying any deductions to the income from the final QC determination. Enter
all countable income. Include prorated amounts from ineligible household members.

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

ci

Deductions:

al

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

or
-f

38. Medical - Enter the amount of the allowable medical expenses for elderly and disabled
household members based on the final QC determination.

O

Do not record the value of the allowable medical deduction ($35). Enter those medical
expenses in excess of $35 per month.

B

M

For example, if a household was billed $100 for medical expenses, enter $65 ($100
minus the medical deduction of $35).

39. Dependent Care - Enter the total dependent care deduction to which the household was

pr
ap

entitled based on the final QC determination.

40. Child Support - Enter the dollar value of the child support payment deduction from the final
QC determination only if the deduction is used instead of the income exclusion.

ov

41. Shelter - Enter the dollar value of the shelter deduction from the final QC determination.

al

42. Homeless - Select the code that applies to this household based on the final QC

1 - Not homeless

3 - Homeless, receiving standard homeless shelter deduction
4 - Homeless, applying actual expenses toward excess shelter deduction

6
02

2 - Homeless, not receiving standard homeless shelter deduction

2
9-

determination.

26

Additional Information on Shelter Costs:

43. Rent/Mortgage - Enter the amount the household was billed for rent/mortgage from the final

ffi
no

U

QC determination. Include taxes, insurance, condo fees and homeowner association fees.

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

ci

a. Usage - Enter the code which describes usage and entitlement to the SUA based on the
final QC determination:

al

or
-f

1 - No utility expenses

2 - Uses actual utility expenses (no standard allowance)

O

3 - Uses HCSUA based on LIHEAP or other similar energy assistance program
payment of more than $20 (only allowed for a household with an elderly or disabled
member)
4 - Uses HCSUA due to heating and/or cooling expense

M

5 - Uses limited utility allowance due to expenses other than heating or cooling

B

6 - Uses phone-only individual standard
7 - Use another individual standard

pr
ap

9 - Other

LIHEAP is the Low-Income Home Energy Assistance Act, your state program may have another
name such as Home Energy Assistance Program (HEAP)

ov

HCSUA is Heating/Cooling Standard Utility Allowance

al

Limited Utility Allowance is a SUA that includes all utilities other than heating and cooling costs and
is for households who do not qualify for the HCSUA.

2
9-

b. Proration - Select the code that identifies whether the SUA amount was prorated if the

State does not mandate the use of SUAs (e.g. prorated among non-household members of
the residence).

2 - Prorated

6
02

1 - Not prorated

27

45. Utilities (SUA or Actual) - This item should be completed for all cases. For households using

ffi
no

U

actual utility expenses, enter the actual amount that was billed for all utilities (gas, water, phone,
electric, etc.) based on the final QC determination. For households using an SUA, enter the
amount of the SUA that was used, based on the final QC determination. Enter $0 if there were no
utility expenses.

SECTION 4 - INFORMATION ON EACH HOUSEHOLD MEMBER

ci

Complete the following section, using information from the final QC determination, for eligible SNAP
households. Enter information on each household member, including individuals whose income and
resources were considered in establishing SNAP benefit level. If the number of household members
exceeds the number of lines available, attach an additional page to allow for coding detailed personlevel information on all SNAP household members. You may currently enter information on up to 16
individuals on the automated system, but you may record information on all household members
using the paper form. If the entire household is ineligible do not enter any information in this section.

or
-f

al

M

O

For disqualified or ineligible SNAP household members, items 46, 47, 48, and 58, if applicable,
(person number, SNAP program participation, relationship to head of household, and dependent care
costs) of this section must be completed. Information on income for these members must also be
recorded in Section 5. For disqualified or ineligible members, the rest of the information in this section
should be completed based on information known through observation or available in the case
record.

B

NOTE: Do not enter zeros in items 48, 50-52, and 54-58 (Relationship to Head of Household, Sex,
Race, Citizenship Status, Employment Status, Work Registration, Employment and Training Program
Status, ABAWD Status, and Dependent Care Cost).

pr
ap

46. Person Number - Assign and enter a number for each SNAP household member (1, 2, etc.).

al

ov

This will include ineligible SNAP household members whose resources and income are
considered in the eligibility determination. Use this assigned number to identify household
members with income in Section 5. Code the head of the household as person 1.

47. SNAP Program Participation - For each person indicate his/her eligibility or ineligibility for

2
9-

participation in the SNAP (i.e., either eligible for participation and entitled to benefits or a reason
for ineligibility. For ineligible non-citizens, whether they participate in a State funded SNAP).

1- Eligible member of SNAP case under review and entitled to receive benefits

6
02

2- Ineligible member - Ineligible non-citizen and is participating in a State-funded SNAP
Program.

3- Ineligible member – Ineligible non-citizen and is not participating in a State funded SNAP
4- Ineligible member - Not paying/cooperating with Child Support agency
5- Ineligible member - Striker
28

6- Ineligible member - Student that does not meet exemptions
7- Ineligible member - Disqualified for intentional program violation

ffi
no

U

8- Ineligible member - Due to disqualification for failure to meet work requirements (work
registration, E&T, acceptance of employment, employment status/job availability, voluntary
quit/reducing work effort, workfare/comparable and workfare).
9- Ineligible member - ABAWD time limit exhausted and the ABAWD is ineligible to participate
due to failure to meet the work requirement at 7 CFR 273.24(a)(1). The ABAWD can
regain eligibility to participate in SNAP by doing any of the following: work at least 80 hours
per month; work and participate in a qualifying work program for a total of at least 80 hours
per month; participate in workfare, become verified by the State.

ci

10- Ineligible member - Fleeing felon or parole and probation violator

al

11- Ineligible member - Convicted drug felon

or
-f

12- Ineligible member - Social Security Number disqualified
13- Ineligible member - Prisoner in detention center
14- Ineligible member - Foster care
99- Unknown

O

M

48. Relationship to Head of Household - Enter the code that shows the relationship (including

B

by marriage) of the person indicated in item 46 (person number) to the head of the household, as
defined by the SNAP Program from final QC determination.

2 - Spouse
3 - Parent
4 - Daughter, stepdaughter, son, stepson

pr
ap

1 - Head of household

ov

5 - Other related person (brother, sister, niece, nephew, grandchild, great-grandchild, cousin)
6 - Foster Child

al

7 - Unrelated person

2
9-

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

6
02
29

50. Sex - Enter the appropriate code:
1- Male

3- Prefer not to answer

ffi
no

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2- Female

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

ci

This is to collect racial and ethnic data on household members when the information is available in
the case record.

or
-f

al

Use codes 1 through 22 to record information if it has been collected. QC reviewers are to collect
only the information that has been recorded on the application.
Information Not Available

1 - The application was not found during the QC review therefore racial/ethnic data is not
available.

Not Hispanic or Latino

3 - American Indian or Alaska Native
4 - Asian

B

M

O

2 - Not recorded on the application for this individual.

6 - Native Hawaiian or other Pacific Islander
7 - White

pr
ap

5 - Black or African American

9 - Asian and White

al

8 - (American Indian or Alaska Native) and White

ov

Multiple races reported

11 - (American Indian or Alaska Native) and (Black or African American)

2
9-

10 - (Black or African American) and White

Hispanic or Latino
13 - (Hispanic or Latino) and (American Indian or Alaska Native)

6
02

12 - Respondent reported more than one race and does not fit into the above categories (code 8
through 11)

14 - (Hispanic or Latino) and Asian
30

15 - (Hispanic or Latino) and (Black or African American)
16 - (Hispanic or Latino) and (Native Hawaiian or Other Pacific Islander)
17 - (Hispanic or Latino) and White

ffi
no

U

Multiple races reported
18 - (Hispanic or Latino) and (American Indian or Alaska Native) and White
19 - (Hispanic or Latino) and Asian and White

ci

20 - (Hispanic or Latino) and (Black or African American) and White
21 - (Hispanic or Latino) and (American Indian or Alaska Native) and (Black or African American)

al

or
-f

22 - (Hispanic or Latino) and Respondent reported more than one race and does not fit into the
above categories (code 18 through 21)

52. Citizenship Status - Enter the appropriate code.
U.S. born citizen
Naturalized Citizen
Non-citizen U.S. National
Lawful permanent resident (LPR) who met or is excepted from the 5-year waiting period
Cuban and Haitian entrant
Compacts of Free Association (COFA) citizens, also known as citizens of Freely
Associated States (FAS)
Lawfully present Non-citizen (no other code applies)
Undocumented non-citizen
Non-citizen, status unknown
Citizen who is not receiving SNAP but whose income and resources must be considered
in determining benefits
Non-citizen who is not receiving SNAP but whose income and resources must be
considered in determining benefits

al

53.

ov

11-

pr
ap

78910-

B

M

O

123456-

0 - None
1 - Grade 1

3 - Grade 3
4 - Grade 4

6
02

2 - Grade 2

2
9-

Educational Level - Enter highest educational level completed for each member of the
household from the final QC determination:

5 - Grade 5
6 - Grade 6
31

7 - Grade 7
8 - Grade 8
9 - Grade 9

11- Grade 11

ffi
no

U

10- Grade 10

12- High school diploma or GED*
13- Post secondary education (e.g. technical education or some college)

ci

14- College graduate or post-graduate degree
99 - Unknown

al

* If member attended grade 12 but did not graduate, use code 11.

or
-f

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

O

M

1- Not in labor force and not looking for work
2- Unemployed and looking for work

4- Migrant farm laborer

6- Self-employed, farming
7- Self-employed, non-farming

2 - 1-19 hours per week

4 - 30-39 hours per week
5 - 40+ hours per week
6 - On medical or parental leave

6
02

3 - 20-29 hours per week

2
9-

1 - Not employed

al

Second box: Hours Worked

ov

8- Employed by other

pr
ap

5- Non-migrant farm laborer

B

3- Active-duty military

32

55. SNAP Work Registration Status - Enter information on the work registration status at the
time of application, recertification, or when a change is reported of all persons as known by the
State agency based on the final QC determination:

1 - Work Registrant

ffi
no

U

0 - Not required - (younger than 16, a 16 or 17-year-old high school student, or 60+years old)

2 - Federal exemption, physically or mentally unfit for employment
3 - Federal exemption, care of a child under 6 or an incapacitated person
4 - Federal exemption, working and/or earning the equivalent of 30 hours per week

ci

5 - Federal exemption, other

al

6 - Federal exemption, complying with work requirement under Title IV of the Social Security Act
7 - Federal exemption, applied for or receiving unemployment compensation

or
-f

8 - Federal exemption, regular participant in a drug addiction or alcoholic treatment and
rehabilitation program
9 - Federal exemption, student enrolled at least half-time in any recognized school, training
program, or institution of higher education

O

B

M

56. SNAP Employment and Training (E&T) Program Status - Enter information on the current
E&T program status of all household members as known by the State agency based on the final
QC determination:

0 - Not participating in any employment and training activity

pr
ap

1 - Participating in non-SNAP E&T activity (such as TANF)

2 - Participating in a SNAP job search/job search training as a mandatory participant
3 - Participating in a SNAP job search/job search training as a voluntary participant

ov

4 - Participating in a SNAP E&T workfare/work experience as a mandatory participant
5 - Participating in a SNAP E&T workfare/work experience as a voluntary participant

al

6 - Participating in a SNAP E&T education/training (basic education, remedial education, career/
technical education, or other postsecondary) as a mandatory participant

8 - Participating in other SNAP E&T component as a mandatory participant

6
02

9 - Participating in other SNAP E&T component as a voluntary participant

2
9-

7 - Participating in a SNAP E&T education/training (Basic education, remedial education,
career/technical education, or other postsecondary) as a voluntary participant

33

ffi
no

U

57. Time-limited Participation Status – Non-disabled adults aged 18 through 64 are subject to a
time limit and are time-limited participants. Time-limited participants are only eligible for 3 months
in a 36-month period (the time-limit) unless they reside in an area where the time limit is
temporarily waived, receives a discretionary exemption from the State, receives 3 additional
consecutive months of eligibility under 7 CFR 273.24(e), are excepted or exempt from time-limits.
For i time-limited participants identified as ineligible, the reviewer must first document the
individual's status under item 47 by selecting Code 10, then by selecting Code 1 under item 57.
To document the status of a time-limited participant as of the review date, enter one of the
following codes:

ci

1- Ineligible household member (Time-limited participant has exhausted time-limited/countable
months)

or
-f

al

2- Time-limited participant meeting work requirement at 7 CFR 273.24(a)(1) (includes good
cause situations)
3- Resides in a waived area

4- Exempt based on a discretionary exemption documented in the case record
5- Time-limited participant receiving a time-limited/countable month (not meeting requirements,
has not exhausted countable months)

O

6- Time-limited participant only eligible for a partial month of benefits

M

7- Excepted person- Not a time-limited participant (meets Indian”, “Urban Indian” and “California
Indian” exception as defined in the Indian Health Care Improvement Act.)

B

8- Excepted person- Not a time-limited participant (Responsibility to care for a dependent child
to those with a child under 14 years of age

10- Good Faith Exemption- AK or HI only

pr
ap

9- Excepted person- Not a time-limited participant (meets another exception listed at 7 CFR
273.24(c)

al

ov

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

2
9-

6
02
34

SECTION 5 - INCOME IDENTIFIED BY HOUSEHOLD MEMBER

ffi
no

U

This section collects detailed information on known income sources, by type and amount, based on
the final QC determination. Information can be collected on up to four sources of income for up to ten
household members. If income exists but is not attached to any specific member, assign the income
to the payee. Enter all income amounts rounded to the nearest dollar.
59. Person Number - Enter the person number from Section 4 for each SNAP household member
with income based on information from the final QC determination.(This number is assigned in
Section 4, item 46).

ci

Source 1

or
-f

al

60. Income Type - (This instruction applies to items 60, 62, 64, and 66). Based on the final QC
determination, identify the type of countable income as listed below for each type of income
received by a SNAP household member.
Earned Income (Not Subsidized)
11 - Wages and salaries
12 - Self-employment

14 - Other earned income

Subsidized Earned Income

M

O

13 - Rental Income when managing the property for an average of at least 20 hours a week

B

16 - Wage supplementation - enter earnings that are above cash assistance and/or SNAP
amount

15 - Energy Assistance income

pr
ap

Unearned Income

31- Retirement, Survivors, and Disability Insurance (RSDI) benefits
32 - Veterans benefits

34 - Unemployment Compensation

37 - Foster care income
42 - Contribution

44 - State general assistance or other State-funded welfare (don't include TANF here)
45 - Educational grants/scholarships/loans
46 - Other (no other option applicable)

6
02

43 - Deemed income

2
9-

36 - Other government benefits (no other option applicable)

al

35 - Workmen's Compensation

ov

33 - SSI

47 - TANF
35

48 - State-only diversion payment
49 - Interest income
50 - Court ordered child support payment received from absent parent or responsible person

52 - Pensions

ffi
no

U

51 - Annuities

53 - Old Age benefits
54 - Survivor's benefits

ci

55 - Striker benefits
56 - Rental income when not managing the property for an average of at least 20 hours a week

al

57 - Alimony

or
-f

58 - Government - sponsored royalties
59 - Government - sponsored dividends
60 - Government - sponsored interest
61 - Trust fund money

M

O

99 - Unknown

pr
ap

Source 2

B

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

62.

Income Type - Second type of income. See item 60.

63.

Amount - Second amount of income. See item 61.

Income Type - Third type of income. See item 60.

65.

Amount - Third amount of income. See item 61.

Income Type - Fourth type of income. See item 60.

67.

Amount - Fourth amount of income. See item 61.

6
02

66.

2
9-

Source 4

al

64.

ov

Source 3

36

SECTION 6 - RESERVED CODING

ffi
no

U

68. Timeliness of Application Processing (Expedited and 30-Day Requirement) - A
determination of timeliness of application processing is to be made for the most recent
application which is for or prior to the sample month in the last 12 months. If there is more than
one application in the last 12 months, measure timeliness for the most recent application. Only
use this process to review an active case in which the most recent application was a new/initial
application. If the most recent application was a recertification application, the case will not be
used in the timeliness of application processing rate.

ci

NOTE: QC policy does not write or develop the review policy for timeliness of application
processing. Please refer to SNAP policy guidance and staff, not QC, with inquiries about the
timeliness measure.

al

Timeliness of application processing according to Federal processing standards:

or
-f

Ŷ A household entitled to expedited service must be provided the opportunity to
participate within 7 days.
Ŷ Households not entitled to expedited service must be provided the opportunity to
participate by 30th day following the date of application.

M

O

An opportunity to participate consists of providing households with an active electronic benefit
transaction (EBT) card and personal identifying number (PIN), benefits have been posted to
the household's EBT account and are available for spending.

B

A case that meets the applicable Federal processing standard is coded 1 - Timely. A case that
fails to meet the applicable Federal processing standard is coded 2 or 3- Not timely. For
example, cases that were delayed due to a late determination for expedited service, whether
the State agency failed to properly screen the case or the client provided incorrect information,
the reviewer should use code 2 - Not timely: 7-day time frame.

pr
ap

ov

The following cases should be coded 4 - Other: cases where no new application was filed
within the last 12 months prior to the sample month, the most recent application was a
recertification (including those filed within 30 days after the certification period expired), and
cases in which the new application was properly pended for incomplete verification. (Cases in
which a new application was improperly pended will be coded 3 - Not timely.)

al

If after a thorough review of case circumstances and records there is no documentation,
application or other information to determine timeliness, the case should be coded 4. For
cases with this problem, every effort should be made to determine the timeliness of the case
before deciding to use the "Other" code.

1- Timely
2- Not timely: 7-day time frame

4- Other

6
02

3- Not timely: 30-day time frame.

2
9-

Please indicate the appropriate code:

37

69.

QC Interview - Enter the appropriate code from the following:
1- Telephonic personal interview with household

3- No Interview with household (Ineligible determination prior to interview)

ffi
no

U

2- No Interview with household - Failure or Refusal to Cooperate OR Not Subject to Review

4- Alaska - remote area - no interview or telephone interview
5- Person interviewed in own home
6- Person interviewed in local office

ci

7- Person interviewed in mutually agreed upon location

al

8- Video interview - person interviewed in own home
9- Video interview - person interviewed in local office

or
-f

0- Video interview - person interviewed in mutually agreed upon location

B

M

O

70. Timeliness of Recertification Processing - A determination of timeliness of application
recertification processing is to be made for the most recent application which is for or prior to the
sample month in the last 12 months. If there is more than one application in the last 12 months,
measure timeliness for the most recent application. Only use this process to review an active
case in which the most recent application was a recertification application, including applications
submitted within 30 days after the end of the certification period. If the most recent application
was a new/initial application, the case will not be used in the timeliness of recertification rate.

pr
ap

NOTE: QC policy does not write or develop timeliness of recertification processing review
procedures. Please refer to SNAP policy guidance and staff, not QC, with inquiries about the
timeliness measure.
Cases where benefits were issued by the household's normal issuance date must be coded 01Timely. Cases where benefit were issued after the household's normal issuance date must be
evaluated for cause of the delay and coded accordingly.

Indicate the appropriate code for 70:

Not Timely - Agency Caused

2
9-

01 – Timely

al

ov

If multiple causes are identified, code the not timely agency or client caused delay that most
appropriately reflects the first cause of the delay. For example, if the agency sent out the Notice
of Expiration (NOE) late and household applied for recertification after the 15th of the month, the
reviewer should use code 11- Not Timely- Agency Caused.

6
02

11 - Agency failed to contact or did not contact client timely. This would include situations in
which the agency failed to contact or did not contact client timely with notice of expiration (NOE),
with recertification packet, to schedule interview, or to request verification.
12 - Agency lost or misfiled the verification or application for recertification. This would include
any lost or misfiled application completed or otherwise.

38

13 - Agency failed to act on completed recertification application. This would include any
completed recertification application that a caseworker failed to act on for whatever reason.

24 - Client did not file the recertification application by the 15th of the last month of the
certification period.

ffi
no

U

Not Timely - Client Caused

25 - Client missed the first scheduled interview.
26 - Client did not return the required verification timely.
27 - Other client caused delay.

ci

Neither timely nor untimely

al

30 - Benefits issued outside the certification period.

or
-f

40 - Not yet due for recertification.

50 - No recertification within the 12 months prior to the sample month.

M

O

71. Allotment Test - Enter the appropriate code that reflects which of the Allotment Tests
(Comparison I or Comparison II) has been recorded in Item #10. Enter one of the following
codes:
1- Comparison I recorded, Comparison II was not needed

B

2- Did Comparison II, recorded Comparison I

3- Did Comparison II, recorded Comparison II

pr
ap

4- Comparison I equaled Comparison II

5- Case ineligible, no Comparison I or Comparison II needed

al

ov

72. Household Zip Code - Enter the household’s five-digit zip code for their physical address. If a
homeless household receives mail, the zip code should be for the location mail is received. QC
cases in which the homeless household does not have a mailing address should use the zip
code for the household’s last known location. If the reviewer is unable to determine a homeless
household’s ‘last known location’, code 99999.

2
9-

1- Face-to-face in local office.
2- Face-to-face in mutually agreed upon location (not own home or local office).
3- Face-to-face in household’s home.

6
02

73. Household Interview- A household interview is required for certifications and
recertifications. Enter the code that accurately reflects the interview method that occurred
between State eligibility and the household at the most recent certification or recertification
action.

4- Telephone interview.
39

5- No interview required based on an approved FNA waiver.
6- No interview required based on an approved FNA demonstration project.

8- Household was not interviewed (no other codes apply)

ffi
no

U

7- Household not interviewed, recertification interview not required since previous interview
was within the previous 12 months.

74. Waiver 1- Enter the code that accurately reflects a waiver applicable to the household’s case.
Do not identify waivers associated with demonstration projects in this item. Select- “2” if the
household participated in a demonstration project.

ci

1- No waivers applicable to case

al

2- Demonstration project

or
-f

3- Interview Waiver (no other code applies)
4- Waiver of the Time Limit
5- Disaster Related
6- Other Waiver

O

B

M

75. Waiver 2- Enter the code that accurately reflects an additional waiver applicable to the
household’s case. Do not identify waivers associated with demonstration projects in this item.
Select- “2” if the household participated in a demonstration project.
1- No additional waivers applicable to case

3- Interview Waiver

pr
ap

2- Demonstration project

4- On-Demand Interview Waiver(no other code applies)
5- Waiver of the Time Limit

7- Other Waiver

al

ov

6- Disaster Related

1- No Demonstration Project applicable
3- Combined Application Project (CAP)
4- Standard Medical Deduction Project (SMD)
5- Other Demonstration Project

6
02

2- Elderly Simplified Application Project (ESAP)

2
9-

76. Demonstration Project - Enter the code that accurately reflects if a demonstration project
applied to the household’s case.

40

77. Demonstration Project 2- Enter the code that accurately reflects if an additional
demonstration project applied to the household’s case.
2- Elderly Simplified Application Project (ESAP)

ffi
no

U

1- No Additional Demonstration Project applicable
3- Combined Application Project (CAP)
4- Standard Medical Deduction Project (SMD)
5- Other Demonstration Project

ci

al

78. Household Veteran/ Active Servicemember Status- Enter the code that accurately reflects if
the household includes a U.S. Veteran, Active Servicemember, or both.

or
-f

1- No U.S. Veteran or Active Servicemember in household
2- Includes a U.S. Veteran

3- Includes an Active Duty U.S. Servicemember
4- Includes both a U.S. Veteran and an Active Duty U.S. Servicemember

O

5- Unable to determine from case record and/or interview

M

SECTION 7 - OPTIONAL FOR STATE USE

B

There are 4 lines of 23 spaces available to the State to code additional information.

pr
ap
al

ov
2
9-

6
02
41