Department of Health and Human Services
Departmental Appeals Board
AFDC QUALITY CONTROL REVIEW PANEL
SUBJECT: Wisconsin Department
of Health and
Social Services
Docket Nos. A-93-005
A-93-006
Decision No. QC 38
DATE:
DECISION
The Wisconsin Department of Social Services (Wisconsin)
appealed the
quality control (QC) review determination of
the Regional Administrator of
the Administration for
Children and Families (ACF) in State QC review
numbers
511381 and 611413. 1/ ACF determined that the
assistance units (AUs) in these cases were overpaid for
their respective
review months of August 1991 (Docket No.
A-93-005) and September 1991
(Docket No. A-93-006).
ACF's determination was based on federal QC
review
findings that the recipients in these two cases did not
furnish social security numbers (SSNs) for their
children.
For the reasons discussed below, we uphold ACF's
determinations.
Relevant Legal Authority
Section 1137(a) of the Social Security Act (Act) provides
that, as a
condition of eligibility for AFDC payments
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. Section 205.52 of 45
C.F.R. 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 .
. . 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 .
. . . 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.
45 C.F.R. � 205.52 (emphasis added).
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 [SSN] . . . (unless an application for a [SSN]
. . . for
the family member 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 Quality Control Manual (QCM) 2/
issued by
ACF contains several options for applying for a
SSN. Under the
Enumeration at Birth (EAB) procedure, the
procedure used by the recipients
in these cases, a parent
may apply for a SSN for a newborn child through the
hospital at which the child is born. The hospital sends
the
necessary information to the state's vital statistics
office, which in turn
transmits the information to the
Social Security Administration (SSA) via
magnetic tape
for automatic issuance of a SSN. 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. Furnishing the SSN upon receipt is now
defined
by regulation as furnishing the SSN to the local agency
by the
next redetermination of eligibility immediately
following receipt of the SSN
or within six months of
receipt, whichever occurs first. 57 Fed. Reg.
46,808
(Oct. 13, 1992) (to be codified at 45 C.F.R. �
205.42(d)(2)(v)(B)); QCM � 3539. A state may also have
an
agreement with the SSA through which the local agency
accepts applications
for SSNs (termed an "agreement"
state). 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. In other cases,
a state may refer an
applicant or recipient to the SSA
District Office to make direct application
for a SSN
(termed a "non-agreement" state). In a non-agreement
state, the applicant or recipient without a SSN must
first provide proof
of application for a SSN and then
furnish the SSN, when received, to the
local agency. 3/
QCM � 3539. Wisconsin is an agreement
state.
Background:
Docket No. A-93-005: LW's 4/ child, JH, was born on
September 23, 1990. LW applied for a SSN for JH under
the EAB
procedure. SSA records indicate that a SSN for
JH was issued on
November 15, 1990. 5/ Ex. H to ACF's
January 21, 1993
brief. In August 1992, LW stated that
she had reported JH's SSN to the
local agency prior to an
April 1991 review. Ex. E to ACF's November
13, 1992
Brief. The record shows that on March 13, 1991, LW did
report a seven digit SSN for JH, as well as nine digit
SSNs for herself
and another child, CH. Ex. A to ACF's
November 13, 1992 brief at page
2L. The record shows
also that LW reported an incorrect nine digit SSN
for JH
during the State QC review in September 1991. September
29,
1992 State Appeal Request, attachment dated September
12, 1991. The
first correct nine digit SSN for JH was
not recorded in the case file until
November 1991. Ex. F
to ACF's November 13, 1992 Brief.
Docket No. A-93-006: SC's child, IC, was born on
September 21,
1990. SC applied for a SSN for IC under
the EAB procedure. SSA
records indicate that a SSN for
IC was issued on November 14, 1990.
Ex. I to ACF's
January 21, 1993 Brief. By the September 1991 review
date, however, SC had not reported IC's SSN to the local
agency.
Wisconsin's Arguments
Wisconsin makes two principal arguments here. First,
Wisconsin
asserts that LW did, in fact, report her
child's SSN prior to the review
date. Second, Wisconsin
asserts that in both cases the recipients were
not
required to provide their children's SSNs upon receipt
because they
had applied for those numbers through
federally developed procedures adopted
by Wisconsin.
In support of its first argument, Wisconsin points to
LW's submission of
an incorrect SSN in March 1991, and
her statement of August 1992, as
evidence that LW did, in
fact, report a SSN for her child. Wisconsin
disputes
that a finding of an overpayment was required by the
statement
in the QCM upon which ACF relied that, "if the
fact that the SSN was
inaccurate should have been
apparent to the caseworker on the face of the
record, an
error can be coded. . ." Wisconsin argues that use of
the word "can" in this sentence implies that ACF has a
choice of whether
or not to find an error here.
Wisconsin maintains that its
interpretation is supported
by 45 C.F.R. � 205.52(c) which provides that the
local
agency will not deny, delay or discontinue assistance
pending
verification of the SSN. Moreover, while
Wisconsin admits that the SSN
was not correctly reported
as of the review date, it argues that
verification of the
SSN is a separate procedure which does not make the
client ineligible. Wisconsin asserts that LW never
refused to
cooperate in submitting her child's SSN, and,
in fact, submitted a nine
digit number to State QC
reviewers in September 1991. Finally,
Wisconsin argues
that ACF has misconstrued the intent of the law (which
Wisconsin asserted was to give states leverage in getting
numbers from
uncooperative clients) in its overpayment
determination
here.
With regard to its second argument Wisconsin asserts,
citing 45 C.F.R. � 205.52(a)(2), that the enumeration
requirement is met
in an agreement state like Wisconsin
if a SSN is issued or an application
for a SSN is made
for each member of the AU. Thus, Wisconsin argues,
as LW
and SC's applications for SSNs for their children were
made via
EAB, and as EAB is a method of applying for a
SSN through procedures adopted
by the state, there is no
regulatory requirement that the SSNs be provided
to the
local agency upon receipt.
Analysis
1. Wisconsin's First Argument: Section 205.52(a) of 45
C.F.R.
requires a recipient to furnish a SSN. A SSN
contains nine
digits. Despite LW's statement that she
had reported her child's SSN
to the local agency prior to
her April 1991 review, there is no evidence in
the record
that she provided a nine digit number until after the
review
date (August 1, 1991).
Pursuant to the QCM, if a QC reviewer discovers that the
SSN of record is
inaccurate, an error "can" be coded if
the fact that the SSN is inaccurate
should have been
apparent to the caseworker on the face of the record.
The QCM requires that evidence of an applicant's SSN as
presented to the
caseworker should be further
investigated by the caseworker if there is
doubt as to
whether the SSN could be a SSN, whether the SSN has
enough
digits in the proper sequence, or whether the name
on the document is the
applicant's name. The QCM states
that only if the inaccuracy could not
have been readily
apparent to the caseworker is no error required to be
coded. Here, LW's caseworker should have realized from
the face of
the document in the case file that the SSN
was incorrect because digits from
the child's SSN were
missing. Thus, this was a situation in which the
QCM
provided that an error "can" be coded.
Wisconsin has interpreted the word "can" as giving the QC
reviewer
discretion to make an error determination in
this situation. We
believe, however, that Wisconsin's
interpretation takes the word "can" out
of the context of
this QCM provision, which ACF reasonably interpreted as
requiring that an error be coded in any case in which the
inaccuracy of
the SSN is apparent from the case file.
Not to treat an obviously
inaccurate SSN as an error in
such situations would undermine the
requirement for
reporting a SSN. The purpose behind the enumeration
requirement is to use recipients' SSNs to obtain
verification of an AU's
income to determine eligibility
and benefits. If LW, or any other
applicant or
recipient, were permitted to fulfill the enumeration
requirement by only reporting part of a SSN, the
enumeration requirement
would be meaningless, as the
local agency would be unable to utilize the SSN
to obtain
the information it needs.
We also disagree with Wisconsin's argument that since 45
C.F.R. �
205.52(c) provides that verification of a SSN is
a procedure separate from
enumeration, LW's submission of
an incorrect SSN prior to the review
date should satisfy
the enumeration requirement here. Wisconsin's
reliance
on section 205.52(c) is misplaced. A seven digit SSN is
incorrect on its face and cannot be verified for
accuracy. Thus,
Wisconsin would not have been denying
assistance "pending verification of
the SSN" within the
meaning of that section if it had not made the payment
in
question.
Wisconsin asserts also that since LW did not refuse to
cooperate no error
should be found. However, we have
previously held that failure to
report a SSN alone is
sufficient to show refusal to cooperate and require
exclusion of the needs of AU members without SSNs. New
Mexico
Human Services Dept., DAB QC15 (1992).
Furthermore, Wisconsin did not
cite any authority (nor
are we aware of any) which indicates that the intent
of
the law was merely to give states leverage in getting
SSNs from
uncooperative clients.
2. Wisconsin's Second Argument: In prior decisions we
have
sustained ACF's findings of erroneous payments in
cases where AFDC
applicants or recipients who have
properly applied for their children's SSNs
through the
EAB procedure have failed to furnish their children's
SSNs
to the local agency upon receipt. We held that it
was not sufficient
to satisfy the enumeration requirement
that an applicant for or recipient of
AFDC actually have
a SSN or have applied for one. An applicant or
recipient
who obtains a SSN must furnish it to the local agency
upon
receipt. Wisconsin Dept. of Health and Social
Services, DAB QC29
(1992); Nebraska Dept. of Social
Services, DAB QC25 (1992); Missouri Dept of
Social
Services, DAB QC22 (1992); DAB QC15. The requirement
that
an applicant or recipient furnish the SSN upon
receipt, however, has
recently been modified for
recipients enumerated through the EAB procedure
to
require that the SSN be furnished by the next
redetermination of
eligibility immediately following
receipt of the SSN or six months from the
date of
receipt, whichever occurs first. This modification
controls our decision in this case, since its effective
date is
retroactive to October 1, 1990. 57 Fed. Reg.
46,782 (Oct. 13,
1992). However, even applying this
modification, the record before us
indicates that LW and
SC both received their children's SSNs more than six
months prior to their respective review dates. 6/
Furthermore, neither woman had reported her child's SSN
to the local
agency by the review date. Thus, even under
this more generous
standard, the SSNs were not reported
timely.
Finally, Wisconsin has argued that the EAB procedure
through which LW and
SC applied for their children's SSNs
was an agreement state procedure and
that it was
therefore unnecessary for them to report the SSNs.
However, as we held in DAB QC29, the EAB procedure does
not constitute
an agreement state procedure since it is
not based on an agreement between
the state and the SSA
through which the state accepts applications for
SSNs.
Even though Wisconsin had such an agreement, applications
for the SSNs in question here were not made pursuant to
its terms, but
rather under the alternative EAB
procedure. Furthermore, applicants or
recipients who
apply for a SSN through agreement state procedures are
not required to report the SSN to the state because the
SSA reports the
SSN directly to the state. There is no
such arrangement under the EAB
procedure. Thus, the
rationale for not requiring recipient reporting
under
agreement state procedures does not apply here.
Conclusion
For the reasons discussed above, we conclude that the AUs
were overpaid
for their respective review months.
Accordingly, we affirm ACF's
determinations.
Leslie A. Sussan
Carolyn Reines-Graubard
Maxine M. Winerman
* * * Footnotes * * *
1. These cases have
been consolidated as the
legal issues in each case are the
same.
2. In this
decision, we refer to the current
version of the QCM, last revised on
October 27, 1992,
unless it differs materially from the version of the QCM
in effect at the time of the local agency
review.
3. However, in
a non-agreement state, if the
state and the SSA have agreed that the state
will provide
local SSA District Offices with welfare identification
numbers for referred individuals, the SSA will provide
the SSNs of those
individuals to the state and the
applicant or recipient does not have to
furnish the SSN
to the local agency. QCM �
3539.
4. We identify
the recipients by their initials
in order to protect their
privacy.
5. SSA
reissued the SSN on November 15, 1991.
By this time, however, LW had
already furnished JH's SSN.
Exhibit H to ACF's January 21, 1993
brief.
6.
Section 3539 of the QCM currently states
that an individual applying for a
SSN should receive the
card within two weeks of the date that the
application is
processed by SSA. The QCM further states that in a
situation where a recipient cannot recall the date of
receipt, the QC
reviewer is to add 15 days to the card's
issuance date as indicated by the
SSA to determine the
date of receipt. Although this language was not
added to
the QCM until September 9, 1991, we find that it is
reasonable
to adopt this methodology for determining a
presumed date of receipt in
these cases, as the date of
receipt is not identified in the record and
neither
mother has asserted that she did not receive her child's
SSN in
a timely manner. Thus, utilizing this
methodology, LW should have
received her child's SSN by
approximately November 30, 1990. Since the
review month
in question is August 1991, LW presumably received the
SSN
eight months before the review month. SC should have
received her
child's SSN by November 29, 1990. Since the
review month in question
for SC is September 1991, SC
presumably received the SSN nine months before
the review
month.
(..continued)