Department of Health and Human Services
Departmental Appeals Board
QUALITY CONTROL REVIEW PANEL
SUBJECT: Hawaii Department
of Human Services
Docket No. A-94-166
Decision No. QC73
DATE: November 28, 1994
DECISION
The Hawaii Department of Human Services (Hawaii) appealed
a June 9, 1994
quality control (QC) determination by the
Regional Administrator of the
Administration for Children
and Families (ACF). ACF determined that
Hawaii's state
QC review had erred in finding that the amount of V.U.'s
Aid to Families with Dependent Children (AFDC) grant had
been
correct. 1/ ACF determined that V.U.'s grant had
been
overpaid $147 because V.U.'s youngest child should
not have been included in
the AFDC assistance unit (AU)
as that child had not yet received a social
security
number (SSN). The state QC review had found no error in
the amount of V.U.'s AFDC grant, although V.U. failed to
supply a SSN
for the child to the local agency as of the
review date of August 1,
1993. Hawaii asserted that V.U.
timely applied to the Social Security
Administration
(SSA) for a SSN for the child, but had not received it as
of the review date. Hawaii argued that V.U. had met the
regulatory
requirements by applying for a SSN for her
child and that she was not
required to provide the SSN to
the local agency until she had received the
SSN from SSA.
For the reasons discussed below, we find that the
evidence contained in
the record before us is not
sufficient to overcome the presumption that V.U.
had
received a SSN for her child before the review date.
Accordingly, we affirm ACF's determination that Hawaii's
state QC review
erred by including V.U.'s youngest child
in determining the amount of the
AFDC grant.
Relevant Legal Authority
Section 408 of the Social Security Act (Act) established
the QC review
process to improve the accuracy of AFDC
payments made to needy families with
dependent children
based on their income and resources. See section
402(a)(7) of the Act. The QC review process provides for
review of
a sample of AFDC cases by each state, and for
review of a sub-sample of
these cases by federal
reviewers. The AFDC QC review panel resolves
"difference" cases, defined as disagreements between
state and federal
review findings that affect a state's
official AFDC payment error
rate. ACF has issued
policies and procedures governing the QC review
process
in the Quality Control Manual (QCM) under which the
states are
required to operate. 45 C.F.R. �
205.40(b)(1).
Section 1137(a) of the Act provides that, as a condition
of eligibility
for AFDC payment under Title IV-A of the
Act, a state shall require that
"each applicant for or
recipient of benefits . . . furnish to the State his
social security account number . . . ." Regulations
implementing this requirement (commonly referred to as
the "enumeration
requirement") were issued in 1986.
These regulations provide in
relevant part that a state
Title IV-A plan must provide that --
(a) As a condition of eligibility, each applicant
for or
recipient of aid will be required:
(1) To furnish to the
State or local agency a
social security account number . . .
and
(2) If he cannot furnish a SSN (either because
such
SSN has not been issued or is not known), to
apply for such number through
procedures adopted
by the State or local agency with the Social
Security
Administration. If such procedures are
not in effect, the applicant or
recipient shall
apply directly for such number, submit
verification of
such application, and provide the
number upon receipt.
45 C.F.R. � 205.52. 2/
Under the Omnibus Budget Reconciliation Act of 1989
setting up the
present QC system, a payment shall be
considered erroneous for QC purposes
if made to a family
"any member of which is a recipient of aid . . . and
does
not have a social security account number (unless an
application
for a social security account number has been
filed within 30 days after the
date of application for
such aid)." Section 408(c)(4)(B) of the
Act.
Section 3539 of the QCM contains several options for
applying for a SSN. In the option applicable to the
facts of this
appeal, an applicant or recipient may go to
the SSA District Office to make
direct application for a
SSN. The applicant or recipient without a SSN
must
provide the local agency proof that the applicant has
applied for a
SSN and then furnish the SSN, when
received, to the local agency.
Section 3539 of the QCM.
3/
Factual Background
The facts of this appeal are relatively straightforward.
V.U. gave
birth to a son, J.A., on March 17, 1993, and
applied for a SSN for J.A. on
April 6, 1993 at the SSA
District Office. When V.U. applied for the
SSN for her
son, she was given SSA form SSA-5028 (Receipt for
Application for a Social Security Number), which contains
the following
language:
Please allow for a reasonable amount of time for
your application
to be processed. However, if you
have not received your Social
Security card after 2
weeks from the date shown above, you should contact
this office or any other Social Security office
convenient to you.
Bring with you the documents you
showed us before to establish your age,
identity and
citizenship or alien status. We will investigate
the
delay and notify you of the number assigned.
In the particular SSA-5028 given to V.U. on April 6,
1993, the SSA worker
crossed out the "2" and wrote in a
"4." Naranjo Declaration, Ex.
3. Thus if V.U. had not
received the card in four weeks, or by May 4,
1993, she
was to return to the SSA District Office.
As of August 1, 1993, the state QC review date, V.U. had
not furnished
J.A.'s SSN to the local agency.
V.U. maintained that she had not received a SSN for her
son as of the
review date. SSA maintained that it
assigned J.A. a SSN on April 14,
1993 and mailed a Social
Security card to V.U.'s address several days
later.
V.U. ultimately reapplied for a SSN for J.A. on March 31,
1994, eight
months after the review date.
Discussion
In its notice of appeal, Hawaii argued that V.U.'s
household had
met the enumeration requirement set forth
at 45 C.F.R. � 205.52 by: 1)
her application for a SSN
for her youngest child; and 2) providing that SSN
to the
local agency upon its "receipt." Hawaii disputed ACF's
position that V.U. was required to reapply for a SSN if
she had not
received the SSN within four weeks of the
initial application. Hawaii
asserted that if a recipient
declares non-receipt of a SSN, the recipient
must be
given the benefit of the doubt.
In support of its contention that V.U. deserves the
benefit of the doubt
that she never received the Social
Security card mailed by SSA, Hawaii noted
that V.U. lives
in a public housing project consisting of 20 buildings
with a total of 118 apartment units; the mailbox
depositories are
centrally located with approximately 60
boxes per location. Hawaii
contended that it is not
unreasonable to conclude that the letter carrier
may, on
occasion, put mail in the wrong box, and that this is
what might
have happened in the case of J.A.'s Social
Security card.
In its acknowledgment of Hawaii's appeal and in response
to the arguments
presented by Hawaii, this panel asked
ACF to address: 1) how it
ascertained that the address
to which the Social Security card was mailed
was, in
fact, V.U.'s residence; and 2) whether the particular
circumstances cited by Hawaii, together with V.U.'s
assertion that she
never received a Social Security card,
were sufficient to overcome the
presumption that, where
there is proof of mailing to an address at which a
person
normally receives mail, the item mailed was received
within a
reasonable time frame of its mailing.
I. SSA mailed the Social Security card to V.U.'s correct
address.
To establish that SSA had sent the card to V.U.'s true
address, ACF
provided V.U.'s April 1993 application for a
SSN, on which V.U. supplied her
address. She supplied
this same address when she reapplied for a SSN
in March
1994. ACF Ex. A. ACF established that V.U. has lived
continuously at this address since July 1989, retaining
the same
mailbox. ACF Ex. G. ACF supplied the printout
of the SSA Numeric
Identification Numident which shows a
SSN assigned to V.U.'s son on April
14, 1993. Naranjo
Declaration, Ex. 2. ACF then explained how
data from an
application is entered into the SSA national online
network
and how a Social Security card is produced (ACF
Ex. E.), and how that Social
Security card is then
automatically mailed (ACF Ex. D). We have
no basis for
concluding that this process was not followed when V.U.
applied for a SSN for her son. In support of its
contention that
SSA had sent the Social Security card to
the correct address, ACF added that
the SSA District
Office had not received any complaints about the
non-
receipt of SSNs from April 1993 to the present. ACF Ex.
B.
We are therefore convinced that SSA did mail the Social
Security card to
V.U.'s correct address.
II. The circumstances of this case do not overcome the
presumption that V.U. received the Social Security card
within a
reasonable time of its mailing in mid-April
1993.
Hawaii based its position on V.U.'s denial of receipt of
the Social
Security card. As stated above, Hawaii argued
that V.U. was not
required to provide the local agency
with a SSN for her youngest child until
V.U. actually
received the SSN from SSA.
Hawaii asserted,
"Regardless of how strongly we feel the
client may have received the card,
we cannot prove beyond
a reasonable doubt that the card was received."
Hawaii
Reply at 2. Proof "beyond a reasonable doubt," however,
is
the standard of proof in a criminal trial and not the
correct standard of
proof to be used in a situation such
as this. The correct standard of
proof, as discussed in
the QCM, is a preponderance of the evidence.
Provisions of the QCM explicitly address the situation
presented by this
case. In cases where an individual has
applied directly to a SSA
District Office for a SSN, the
QCM sets forth the following procedures a
state must
follow when the recipient denies having received the
Social
Security card:
Any conflicts in information regarding whether, or
when the SSN
card was received must be resolved.
If, for example, the recipient
alleges non-receipt
of the SSN, yet a document or information from SSA
indicates that it was issued, resolve this
contradiction by questioning
the recipient further,
and/or by making collateral contacts. Then
decide,
based on an evaluation of all the facts of the case,
along with
the preponderance of the evidence
gathered, whether an error exits because
the
recipient received the SSN prior to the review date,
but did not
furnish it to the local agency.
Generally, an individual applying for
an SSN should
receive the card within two weeks of the date that
the
application is processed by SSA. Follow these
guidelines when the date
of receipt of an SSN is
questionable:
c. Additional development is necessary when the
recipient alleges s/he did not receive the
card, or receipt of the
number was more than
one calendar month after the date of
issuance
reflected in SSA's records. If the
additional information
substantiates the
recipient's allegation, accept the
recipient's
allegation regarding the date of
receipt. If not, establish the date
of
receipt by adding 15 days to the issuance
date reflected in SSA's
records.
QCM V-54, V-55 (emphasis added).
Thus, rather than just relying
on V.U.'s assertions that
she never received the Social Security card,
Hawaii was
required to gather additional information to substantiate
V.U.'s claim of non-receipt. For whatever reasons,
Hawaii did not
undertake such additional development and,
instead, relied solely on V.U.'s
credibility in claiming
non-receipt.
In its presentation of its position in this appeal, ACF,
on the other
hand, engaged in the type of record
development mandated by the QCM.
Concerning Hawaii's
allegation that V.U. lives in a large housing project
with the tenants' mailboxes in depositories of 60 boxes
per location,
suggesting the possibility that a letter
carrier may have placed V.U.'s mail
in the wrong box, ACF
sought information from various sources about mail
delivery in the housing project. ACF contacted the
manager at
V.U.'s public housing project who stated that
their files did not indicate
any complaints by V.U. for
non-delivery of mail, lost keys to the mailbox,
or
vandalism to her mailbox. ACF Ex. G. Each individual
mailbox can only be opened by a key given to each tenant
by the housing
authority. ACF Ex. I. ACF also contacted
a postal inspector and
determined that V.U. had never
filed any complaints with the Post Office
about the
delivery of her mail or vandalism to her mailbox. ACF
Ex. J. ACF also learned that each tenant's name is
clearly written
on the inside of each individual's
mailbox, and the address is displayed on
the front of
each mailbox. Id. ACF confirmed this by having one
of
its employees visit the mail depositories. The ACF
employee
determined that V.U.'s address was engraved on a
metal tape on the front of
her mail box. Nakamura
Declaration, 7.
Hawaii
could have undertaken this type of record
development, but chose instead to
rely on V.U.'s
credibility. With regard to V.U.'s credibility, ACF
discovered that V.U. had a history of failing to provide
the local
agency with the SSNs for her other children in
a timely manner.
4/ Nakamura Declaration, 9.
Hawaii did not deny
the validity of ACF's references to
V.U.'s history, but strongly objected to
any references
to V.U.'s behavior outside the review period and
contended that these references were inappropriate and
irrelevant to the
specific question of when or whether
V.U. received J.A.'s Social Security
card.
We disagree. These references go directly to V.U.'s
credibility and
are relevant to this appeal. V.U.'s
failure to submit SSNs for her
other children in a timely
fashion shows a pattern of behavior and is
particularly
relevant to the issue before us. The QCM directs a state
to resolve all conflicts about the receipt of a Social
Security
card. The QCM directs the state to question the
recipient and seek
collateral information. Here Hawaii
simply relied on V.U.'s
word. Hawaii's investigation was
not sufficient. A review of
V.U.'s file should have led
Hawaii to conduct a more thorough
investigation. Hawaii
abdicated its responsibility to carefully
monitor V.U.'s
case. From the record before us, we conclude that the
evidence supports the presumption that V.U. did, in fact,
receive a SSN
for her youngest child months before the
review month, but failed to submit
that number to the
local agency. Accordingly, including J.A. in the
AU,
despite the lack of a SSN for him, was an error the
Hawaii QC review
should have found.
Conclusion
For the reasons discussed above, we find that there was
an overpayment in
V.U.'s AFDC grant of $147 because of
the lack of a SSN for V.U.'s youngest
child.
___________________________
Thomas D. Horvath
___________________________
Peggy McFadden-Elmore
___________________________
Maxine Winerman
* * * Footnotes * * *
1. In order to protect
V.U.'s privacy, this
AFDC recipient is identified by her initials. The
Hawaii
QC review number for V.U. is
08-0012.
2. Hawaii
also incorporated the requirements of
45 C.F.R. � 205.52 into the Hawaii
Administrative Rules
(HAR) at HAR � 17-655-12.
3. Another option
is the Enumeration at Birth
procedure, under which a parent may apply for a
SSN for a
newborn child through the hospital at which the child is
born. The QCM provides that, where this option is used,
proof of
application must be provided for the case file
and the applicant or
recipient must furnish the SSN to
the local agency upon its receipt. A
state may also have
an agreement with the SSA through which the local agency
accepts applications for SSNs (termed "agreement"
states). Once
proof of application is in the case file,
an AFDC applicant or recipient
does not have to provide
the SSN, when received, to the local agency,
because SSA
sends the number directly to the agency.
4. The Social Security
card for V.U.'s oldest
child was issued on June 8, 1989, but that child's
SSN
was not submitted to the local agency until November 22,
1989.
V.U.'s second child's Social Security card was
issued on May 30, 1991, but
the SSN was not submitted to
the local agency until January 16, 1992.
Nakamura
Declaration, 9.
(..continued)