Department of Health and Human Services
Departmental Appeals Board
AFDC QUALITY CONTROL REVIEW PANEL
SUBJECT: New Mexico Human
Services Department
Docket No. A-91-102
Decision No. QC2
DATE: October 4, 1991
DECISION
The New Mexico Human Services Department (State) appealed
the June 6,
1991 Aid to Families with Dependent Children
(AFDC) quality control review
determination by the Acting
Regional Administrator of the Administration for
Children
and Families (Agency). The Agency determined that J.C.
1/ was ineligible for $63 of the $269 AFDC payment she
received
during the review month of December 1990. This
determination was based
on a federal quality control
review finding that J.C.'s youngest child was
not
properly enumerated. For the reasons stated below, we
agree
with the Agency that this child was not properly
enumerated.
Therefore, we uphold the Agency's decision.
Relevant Statutory and Regulatory Provisions
Section 402(a)(25) of the Social Security Act (Act)
requires that a
state's title IV-A plan "provide that
information is requested and exchanged
for purposes of
income and eligibility verification in accordance with a
State system which meets the requirements of section 1137
of this
Act." Section 1137 in turn provides that, as a
condition of
eligibility for title IV-A payments, a state
shall require that "each
applicant for or recipient of
benefits . . . furnish to the State his social
security
account number . . . ." Section 1137(a)(1). This
information is to be utilized primarily to obtain wage
information from
various state and federal agencies to
verify the applicant's eligibility and
the amount of
benefits to which the applicant is entitled. See section
1137(b). Section 408(c)(4) of the Act (42 U.S.C. section
608(c)(4)), which applies to erroneous payments made
after fiscal year
1990, states that "[n]otwithstanding
any other provision of this section, a
payment shall be
considered an erroneous payment if the payment is made to
a family . . . (B) any member of which is a recipient of
aid under a
State plan approved under this part and does
not have a social security
account number (unless an
application for a social security account number
for the
family member has been filed within 30 days after the
date of
application for such aid)."
Regulations implementing the requirement for a social
security number
(SSN) (referred to by the Agency as the
"enumeration requirement") appear at
45 C.F.R. 205.52,
which states in pertinent 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, hereinafter referred
to as the SSN . . . ; 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 its
receipt. 2/
The record does not indicate what provisions concerning
the enumeration
requirement, if any, were in the State's
IV-A plan. However, the
following provisions were
included in State ISD Manual Section No. FA
312(1987):
In order for a person to be included in the
assistance unit, s/he
must report his or her social
Security Number to the HSD.
If any such person does not have a validated Social
Security
Number, s/he must apply for one as a
condition of qualifying for
assistance. Application
is made by completing form SS-5 and giving it
to the
eligibility worker. The person must also present
documents
verifying age, citizenship and identity.
The Agency acknowledged that these provisions constitute
"permissible
State practice" consistent with federal law.
Agency Response,
September 6, 1991, page 4.
The AFDC Quality Control Manual issued by the Agency
states that "[t]he
QC review is to be conducted against
`permissible state practice'
(PSP)." QC Manual,
Appendix W, p. 1.
Factual Background
On May 18, 1990, J.C. applied for AFDC benefits for
herself and her two
children, E.R. and N.C. In
accordance with applicable requirements,
J.C. supplied
SSNs for herself and her older daughter, E.R. However,
she was unable to furnish a SSN for her younger daughter,
N.C., because
N.C.'s social security card (SSC),
originally issued in September 1989, was
lost or
destroyed and J.C. did not know the number. State Appeal
Request at 1.
As of the review date, the local agency case record
concerning N.C.'s SSN
contained: 1) an undated form
letter, "Message from Social Security,"
concerning when
the parents would receive their baby's SSN, ostensibly
given to J.C. when she first applied for a SSN for N.C.
under the
enumeration at birth project. State Appeal
Request, Exhibit 1,
Attachment 2; 2) an unsigned form
SS-5 "Application for a Social Security
Card," dated June
13, 1990. State Appeal Request, Exhibit 1,
Attachment 3;
and a State Form ISD 110 "Referral for Social Security
Number," which J.C. was to give to the Social Security
Administration
(SSA) when she applied for N.C.'s SSN and
which was to be returned to the
State by SSA. The
portions of this form to be filled out by SSA are
blank.
State Appeal Request, Exhibit 1, Attachment 4. 3/
State QC review found that the enumeration requirement
in this case was
met as of the review date. This finding
was based upon indications
that a SSN had been issued
prior to application, as evidenced by the
"Message from
Social Security" indicating that at one time an
application for a SSN for
N.C. had been filed, and on the
presence in the case record of the
SS-5. State Appeal
Request, Exhibit 1, Attachment 5, QC Worksheet,
Element
170. 4/
Federal QC review verified that on September 1, 1989,
N.C. was issued a
SSN, but found that there was no
evidence in the case record that her SSN
was reported to
the local agency. Federal QC review also noted that
the
SS-5 of June 13, 1990 did not meet SSA's evidentiary
requirements,
as no evidence of identity for N.C. was
provided. Federal QC review
then determined that since
no SSN was furnished to the local agency, the
case had
been overpaid $63. State Appeal Request, Exhibit 1,
Attachment 8.
The State appealed and on June 6, 1991, the Agency upheld
the federal QC
review determination concerning the $63
overpayment. The Agency
concluded that there was no
acceptable evidence that J.C had applied for a
SSN on
N.C.'s behalf, nor was there evidence that a number was
ever
reported to the State. The Agency specifically
found that the
procedures regarding proper documentation
of an application for a SSN
required by the State Manual
were not followed. State Appeal Request,
Exhibit 2.
On appeal, the State argued that for purposes of QC
review, both federal
statute and permissible State
practice precluded a finding of error.
The State
asserted that the express language of section 408(c)(4)
only
considered as QC errors AFDC payments made to family
members who had no SSN
and had not filed an application
for a SSN. Thus, in the State's view,
the mere fact that
N.C. had a SSN, although it was unknown and unreported,
was sufficient to preclude a finding of error. The State
also
contended that although federal regulations required
a second application
for a SSN because N.C.'s SSC had
been lost and the number was unknown,
failure to meet the
technical requirement of enumeration in this case should
not result in a QC error where the applicable statute
provides
otherwise. The State argued in the alternative
that the technical
requirement of enumeration was met in
this case by N.C.'s June 13, 1990
application for a SSN.
The State asserted that a completed form SS-5
was
provided to the eligibility worker (EW) in accordance
with
permissible State practice. The State also
asserted, and the Agency
did not dispute, that there was
no indication that any response to this SS-5
application
was ever received. Thus, the requirement in the State
Manual that an applicant report his or her SSN would not
be
applicable. State Appeal Request, June 26, 1991,
pages 1 - 5; State
Reply, September 19, 1991, pages 1-4.
Discussion
Enumeration provides the AFDC program a means of
verifying an applicant's
income in order to determine the
applicant's eligibility and benefit
level. An applicant
may have received a SSN prior to application, but
the SSN
serves no purpose if the applicant does not make the AFDC
staff
aware of it. 5/
In essence, the State is asserting that section 408(c)(4)
of the Act is
inconsistent with the enumeration
requirement as set forth at 45 C.F.R.
205.52. The State
is contending that because N.C. had a SSN as of the
review date, even though it was not available to the
local agency, N.C.
should be considered properly
enumerated for AFDC purposes. We
disagree, and find that
these sections are consistent.
Section 408(c)(4) cannot be applied in a vacuum.
Instead, it must
be applied in such a way as to fulfill
the purpose of enumeration --
validation of eligibility
and income levels. Validation cannot be
accomplished
where an applicant to whom a SSN was previously issued no
longer knows the SSN. If an applicant is unable to
furnish his or
her SSN to the local agency, he or she
must apply for the SSN not to fulfill
some technical
requirement, but so that the local agency can validate
eligibility and income levels. Federal regulations at 45
C.F.R.
205.52 further the purposes of Section 408(c)(4)
by requiring that a state
title IV-A plan must provide
that when an applicant cannot furnish his or
her SSN,
either because it has not been issued or is not known,
the
applicant must apply for a SSN through procedures
adopted by the state or
local agency with SSA.
New Mexico's Manual regarding enumeration provides that,
if an applicant
for AFDC does not have a validated SSN,
he or she must apply for one.
Application is to be made
by "completing" Form SS-5 and giving it to the EW
with
documents verifying age, citizenship and identity. In
this
case N.C.'s SSC had been lost or destroyed and J.C.
had no record of N.C.'s
SSN. As J.C. could not furnish a
valid SSN for N.C., it was incumbent
upon her both by
federal law and State practice, which was presumably
consistent with the State's IV-A plan, to apply for a SSN
for her
daughter. The record fails to establish,
however, that this was done
in accordance with the State
Manual.
Specifically, the local agency case record contained a
form SS-5 for
N.C., which J.C. did not sign. State
Appeal Request, Exhibit 1,
Attachment 3. There is no
evidence in the record that the SS-5 was
accompanied by
documents verifying N.C.'s age, citizenship and identity.
There is also nothing in the case record to show that as
of the
review date a completed application for a SSN had
been made on N.C.'s behalf
to SSA or that a SSN was later
furnished to the local agency.
Since, as of the review date, N.C.'s SSN was not reported
to the State,
and since, as of the review date, there is
no evidence that a completed
application for a SSN was
filed with SSA, we conclude that N.C. was not
properly
enumerated as of that date.
Conclusion
For the reasons discussed above, we conclude that $63 of
the $269 payment
made to J.C. in December 1990 was
incorrect. Accordingly, we affirm
the Agency's
determination.
Carolyn Reines-Graubard
Maxine Winerman
Carmen Cafasso
* * * Footnotes * * *
1. We identify the recipient
by her initials in
order to protect her privacy. The State quality control
review number is 2111.
2. A more detailed
background on the enumeration
requirement is provided in North Carolina
Department of
Human Resources, DAB QC 91-88, pages 2 - 4.
3. The record also contains
a card bearing the
notation "I'm a Girl", followed by data concerning N.C.
from an unspecified source. State Appeal Request,
Exhibit 1,
Attachment 2. The State did not rely on this
document.
4. State QC
review also noted that computer
records showed SS-5's sent for N.C. on
7/16/90 and
11/6/90. There were, however, no copies of these SS-5's
in
the local agency case record and no SSN was received
as a result of their
purported submission. State QC
review also noted that J.C. applied directly
to SSA for a
SSN for N.C. on 1/8/91. State QC review then noted that
the
SSN had not yet been received. State Appeal Request,
Exhibit 1, Attachment
5, Element 170.
5. In North Carolina
Department of Human
Resources, DAB QC 91-88, this Panel held that a SSN was
provided to AFDC when it was provided to the Food Stamp
program which
was a part of the same local agency, noting
that the AFDC Quality Control
Manual defined "Local
Agency Case Control Record" as "[a]ll information
available to the local agency for use in making an
eligibility and
payment determination including
information stored by automated
systems." Manual,
section 3030. In contrast, in this case there
is no
evidence that N.C.'s SSN was provided to any entity whose
files
would be part of a "Local Agency Case Control
Record."