Department of Health and Human Services
Departmental Appeals Board
QUALITY CONTROL REVIEW PANEL
SUBJECT: Washington Department
of Social and Health Services
Docket No. A-93-26
Decision No. QC39
DATE: February 23, 1993
DECISION
The Washington Department of Social and Health Services
(Washington)
appealed an October 20, 1992 quality control
(QC) review determination by
the Regional Administrator,
Region X, of the Administration for Children and
Families
(ACF). ACF determined that the Washington QC review had
erred in finding that the amount of S.Y.'s Aid to
Families with
Dependent Children (AFDC) grant was
correct. 1/ ACF
determined that there was an
overpayment of $103 in S.Y.'s AFDC grant
because one of
her children did not have a social security number (SSN)
as of the review date of March 1, 1992.
For the reasons discussed below, we sustain ACF's
determination that
Washington had erred in finding that
the amount of S.Y.'s AFDC grant was
correct.
Relevant Legal Authority
Section 1137(a) of the Social Security Act (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 its receipt.
45 C.F.R. � 205.52.
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 Quality Control Manual (QCM) issued
by ACF contains
several options for applying for a SSN.
2/ Under the
Enumeration at Birth (EAB) procedure, 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 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. A state
may also have an agreement with the Social
Security
Administration (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. In other cases,
a state
may refer an applicant or recipient to the SSA
District Office to make
direct application for a SSN
(termed "non-agreement" states). 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.
Section 3539 of the QCM.
Factual Background
On September 24, 1991, S.Y. applied for AFDC benefits for
herself and her
son. S.Y.'s son did not have a SSN at
that time. On October 3,
1991, the Washington Community
Service Office (CSO) gave S.Y. an application
form for a
SSN to be submitted to the SSA District Office on her
son's
behalf. 3/ S.Y. immediately took the form to the
local SSA
District Office.
SSA refused to accept the application. Although the box
on the form
"Application Not Accepted" was not checked, a
SSA representative wrote next
to the box, "See below" and
drew an arrow to the comment line on the form,
where the
employee wrote, "We will not accept letters from out of
state." S.Y. returned the form to the CSO on the same
day, October
3, 1991.
Still on October 3, 1991, the CSO, having received notice
that S.Y. had
applied for a SSN for her son and
apparently believing the application had
been accepted,
authorized AFDC eligibility for the son. On December 4,
1991, the CSO received a copy of the son's Certified
Abstract of Birth
from the San Diego County (Ca.)
Recorder. On February 2, 1992, the CSO
sent a letter to
S.Y. requesting the SSNs of her children. On February
27, 1992, S.Y. furnished her daughter's SSN, but not her
son's.
On March 6, 1992, the Washington QC reviewer found that
S.Y.'s case was
correctly paid.
On April 10, 1992, approximately five weeks after the
Washington QC
review, a completed SSA form SS-5, which
included the Certified Abstract of
Birth, was filed for
S.Y.'s son with SSA. On April 20, 1992, SSA
issued a SSN
for S.Y.'s son.
The federal QC reviewer determined that the Washington QC
review had
erred in finding that this case was correctly
paid. The federal QC
reviewer found that the case was
overpaid $103 because S.Y.'s son did not
have a SSN. The
federal QC reviewer reported that S.Y.'s October 3,
1991
application had been rejected because S.Y. "could not
provide
acceptable evidence of age, citizenship, and
identity of the child."
Discussion
Washington is a non-agreement state. As discussed above,
this means
that Washington may refer an AFDC applicant or
recipient such as S.Y. to a
SSA District Office to make a
direct application for a SSN for herself or a
family
member. The AFDC applicant or recipient without a SSN
must
provide the local agency proof of application for a
SSN and then furnish the
SSN, when received, to the local
agency.
Here the CSO referred S.Y. to the SSA District Office to
apply for her
son's SSN. There S.Y. did submit an
application. The question
before us is whether S.Y.'s
submission of an application in the particular
circumstances of this case is sufficient to satisfy the
statutory and
regulatory requirements of enumeration and
to thus qualify for AFDC
benefits.
Washington contended that its CSO, in authorizing AFDC
eligibility for
S.Y.'s son, followed proper procedures.
Washington argued that the SSA
representative had not
checked the box indicating that S.Y.'s application
was
not accepted, but had only written that a particular
document S.Y.
had submitted was "from out of state" and
therefore unacceptable.
According to Washington, the CSO
could reasonably have interpreted this as
merely being
informational in nature. Washington stated that SSA has
a whole hierarchy of evidence concerning acceptable
documentation upon
which to base issuance of a SSN, and
that there was no indication on the
form as to what the
"out of state" document was or whether it was important
or even required. Washington stated that there was
nothing on the
form to suggest, as the federal QC
reviewer found, that the application was
rejected because
"the recipient could not provide acceptable evidence of
age, citizenship, and identity of the child."
According to Washington, this case raised the issue of
detrimental
reliance. Appendix W of the QCM provides
that an erroneous payment is
excludable if the payment
"is in error solely by reason of `the
State's reliance
upon and correct use of erroneous information provided by
the Secretary about matters of fact' . . ." Appendix W
states that
"`reliance upon and correct use of erroneous
information' means that the
State depended on the
information to make payment decisions, had a
reasonable
expectation that the information was timely and accurate
and
followed procedures for access and use of this
information."
Washington argued that this case meets the
criteria of the Detrimental
Reliance provision because
its CSO relied upon the assumption that the DSHS
14-167
form had been completed correctly by SSA and that the
form showed
that SSA had accepted S.Y.'s application for
a SSN for her son.
Washington further disputed the federal QC reviewer's
assertion that
nothing in the AFDC regulations provides
that an applicant's or recipient's
unsuccessful attempt
to apply for a SSN may be considered as meeting the
enumeration requirement. Washington contended that this
position
conflicts with 45 C.F.R. � 205.52(a)(2).
Washington argued that if a
client provides a SSN or
follows the procedures for applying for a SSN,
assistance
cannot be delayed, denied, or terminated. Washington
referred to language in 45 C.F.R. � 205.52(b) that a
state or local
agency "will comply with the procedures
and requirements established by
[SSA] for application,
issuance, and verification of [SSNs]."
Washington stated
that this language cannot be interpreted to mean that the
client must submit a "successful" application for a SSN.
Washington insisted that under the common understanding
of the
word "apply," S.Y. indeed did apply for a SSN as
required in 45 C.F.R. �
205.52(a)(2). Washington
maintained that it was compelled to provide
AFDC
assistance to S.Y. and her son by 45 C.F.R. � 205.52(c),
which
provides, "The State or local agency will not deny,
delay, or discontinue
assistance pending the issuance or
verification of [SSNs] if the applicant
or recipient has
complied with the requirements of [� 205.52(a)]."
Washington's position in this appeal hinges on its
contention that its
CSO acted reasonably when it
determined SSA had accepted S.Y.'s
application. We find,
however, that there is no reasonable way that
the SSA
representative's comments on the form could be read as an
acceptance of the application.
When S.Y. returned the DSHS 14-167 to the CSO, there
should have been no
doubt that the application had been
deemed unacceptable by SSA. While
it is true that the
box "Application Not Accepted" was not checked, that
segment of the form bore the message "See below" with an
arrow to the
phrase, "We will not accept letters from out
of state." We consider
this to be an unambiguous
statement that SSA considered the application
deficient
because it lacked necessary evidentiary support. If, as
Washington argued, the quoted statement was merely
informational in
nature or meant that only one particular
document was unacceptable (meaning
that other documents
S.Y. submitted were acceptable evidence), the question
arises as to why, if other acceptable evidence had been
presented, the
SSA representative bothered to write, "We
will not accept . . ." The
logical answer is that no
acceptable evidence was presented and that the
application was rejected. Washington's explanation that
the CSO
made a reasonable interpretation of the SSA
response on the form is simply
not persuasive.
Even if we were to give the CSO the benefit of the doubt
by saying that
SSA's response on the form was ambiguous,
we still would not find that the
CSO acted properly by
immediately including S.Y.'s son in her AFDC
grant. In
ambiguous situations, where federal dollars are at stake,
the CSO had the obligation to inquire further about the
status of S.Y.'s
application. We question how difficult
it would have been for the CSO
to contact the SSA
representative to eliminate any doubt about the
application.
As we have found that the SSA representative provided no
erroneous
information here, we find that there is no
issue of detrimental
reliance. Appendix W of the QCM
states that, in order for detrimental
reliance to apply,
a state is required to have "a reasonable expectation
that the information was . . . accurate." As stated
above, we do
not find the CSO's interpretation to have
been reasonable.
Additionally, we do not share Washington's view that
S.Y.'s mere
application for a SSN, even though
unsuccessful, required Washington to
include her son in
the AFDC grant. There is no question that S.Y.
applied
for a SSN for her son. But � 205.52(a)(2) requires more
than an application. That regulation requires an
application, a
verification of the application, and a
provision of the SSN upon
receipt. Here S.Y. was not
able to provide her son's SSN until April
20, 1992 at the
earliest, some six months after the CSO approved her
son's inclusion in the AFDC grant. The provisions of �
205.52(c)
cited by Washington as compelling it not to
deny assistance to S.Y.'s son
are contingent upon
compliance with the provisions of � 205.52(a)(2).
Those
provisions were not complied with here as S.Y. failed to
timely
provide the CSO with her son's SSN.
We have previously declared:
The purpose of the enumeration requirement is not to
see that all
AFDC recipients have SSNs. The purpose
is to use recipients' SSNs to
obtain verification of
an [Assistant Unit]'s income in order to determine
eligibility and benefits. To this end, the
regulations
specifically require that all members of
an AU without a SSN apply for one
and then furnish
the SSN upon receipt. 45 C.F.R. � 205.52. If
verification of application for a SSN sufficed, once
an applicant or
recipient had verified the filing of
an application for a SSN, that
applicant or
recipient would never have to report the SSN to the
local
agency, thus defeating the purpose of the
enumeration requirement.
Missouri Dept. of Social Services, DAB QC22, at 5 (1992).
That same
reasoning is applicable here.
Conclusion
For the reasons discussed above, we sustain ACF's
determination that
Washington's QC review erred in not
finding an overpayment in S.Y.'s AFDC
grant.
___________________________
Carmen Cafasso
___________________________
Maxine
Winerman
___________________________
Thomas
D. Horvath
* * * Footnotes * * *
1. In order to protect
her privacy, this AFDC
recipient is identified by her initials. The
Washington
QC review number is
001121.
2. In this
decision, we refer to the current
version of the QCM, last revised on
October 27, 1992.
This revision specifically stated that any changes
reflect the regulations implementing section 408 of the
Act, effective
with the October 1990 review month.
Unless it differs materially from
the version of the QCM
in effect at the time of the local agency review, we
refer to the latest version of the
QCM.
3. Washington had
entered into an agreement
with the SSA regional office to develop
procedures,
including a new form, for the enumeration of public
assistance applicants. This form, Enumeration Referral
(DSHS
14-167), was designed to be a turn-around form for
the purpose of verifying
a SSN or determining that an
application for a SSN had been made. The
DSHS 14-167 is
initiated by a CSO financial worker and given to the
client to take to the SSA District Office. A SSA
representative
completes the section on the form titled
"For SSA Response Only" and the
client returns the form
to the CSO. According to Washington, if the
SSA
representative checks the box under "Application Not
Accepted," the
SSA representative is to specify what the
client must do for the application
to be accepted.
(..continued)