N.J. Admin. Code § 10:90-14.5

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:90-14.5 - Reimbursement of assistance for cases pending SSI entitlement

(a) A contractual agreement between the Social Security Administration (SSA) and the State of New Jersey provides for reimbursement to DFD for assistance granted to individuals while awaiting an initial SSI eligibility determination or during the period of time in which a client is awaiting a reinstatement of terminated or suspended SSI benefits. In such instances, the SSA/District Office (DO) may refer such persons to the agency for WFNJ/GA.

(b) When the SSA/DO refers an individual to the county/municipal agency, such referral shall be made on the form entitled Social Security Referral for Services, two copies of which shall be given to the client to take to the agency.

1. If the application for WFNJ/GA results in denial, the county/ municipal agency shall file both copies of the referral form in the case record and take no further action. If the application for WFNJ/GA is approved, one copy of the referral form shall be retained by the agency in the case record, and the other returned to the SSA/DO with a letter stating that the individual concerned is receiving WFNJ/GA.

(c) When an individual is about to apply or has already applied for SSI, or is awaiting a reinstatement of terminated or suspended SSI eligibility, the agency shall require that he or she sign Form WFNJ/GA-30, "Authorization for Reimbursement of Initial Supplemental Security Income (SSI) Payment, or Initial SSI Posteligibility Payment," and Form WFNJ/GA-30A, "Agreement to Repay Assistance from Initial SSI Payment," before granting assistance. These forms pertain to the client's obligation to repay the agency for assistance (including Emergency Assistance/Temporary Rental Assistance) granted during the interim pending the client's SSI initial or posteligibility entitlement. The WFNJ/GA-30 is prepared and forwarded to the SSA as described in (c)l below. This form authorizes the SSA to forward a client's initial or initial posteligibility SSI benefit award payment directly to the treasurer of an agency so that repayment of assistance may be accomplished. A copy of Form WFNJ/GA-30A is prepared at the time of application and is retained in the case record. This form contains a repayment agreement which is to be enforced in cases in which, for whatever reason, the initial, or initial posteligibility SSI payment is sent directly to the client.

1. Completed and signed WFNJ/GA-30 forms shall be submitted by registered mail to SSA/DO within 24 hours of the date the client signs the authorization form and routed in accordance with the following provisions.

i. Three copies of Form WFNJ/GA-30 shall be prepared with the front side of each copy signed by the client and the reverse side signed by the agency director;

ii. The original form shall be submitted to SSA/DO;

iii. The first copy shall be retained in the agency's files; and

iv. The second copy shall be given to the SSI client.

2. When both spouses are applying for SSI, separate sets of the WFNJ/GA-30 and the WFNJ/GA-30A shall be completed for each individual.

3. In any case in which the retroactive SSI check is sent directly to the client, the agency shall compute the reimbursement due in accordance with (d) below and shall seek repayment from the client on the basis of the WFNJ/GA-30A agreement. The WFNJ/GA-30A is to be prepared in duplicate, the client is to receive a copy, and the original is to be retained in the agency's file.

(d) Since the initial check received by the CFO/treasurer will cover the initial retroactive or initial posteligibility SSI award for one eligible person only, deductions when both spouses are involved shall be computed as follows:

1. When both spouses filed and both are found eligible for SSI, the amount of Interim Assistance previously granted to each individual is deducted from his or her separate SSI award;

2. When both spouses filed and only one is determined eligible, the amount of the eligible person's portion of the Interim Assistance payment shall be deducted from the SSI award;

3. When only one spouse is found eligible and the other spouse is designated as an "ineligible spouse," the amount of Interim Assistance received by both persons shall be deducted from the amount of the SSI award.

(e) Rules concerning remittal of balance of SSI award to clients are:

1. Form SSA-(L)8125, Social Security Administration Supplemental Security Income Notice of Interim Assistance Reimbursement, provides the necessary information (SSI eligibility date, payment summary, client's address) to permit distribution of any proceeds due the client from the initial SSI award check, which shall be done as follows:

i. If a month is not listed on the "Payment Summary" segment of the SSA-(L)8125 form, the agency shall not recoup payment of interim assistance provided for that month.

ii. Form SSA-(L)8125 shall be appropriately completed, signed, dated and mailed to the New York SSA office no later than 30 calendar days after the Treasurer's receipt of the SSI award check.

iii. If Form SSA-(L)8125 is not received prior to Treasurer's receipt of the SSI award check, the local SSA/DO shall be contacted by the agency, within a period of not more than three working days, to obtain the necessary information to permit distribution of the proceeds due the client from the SSI award check.

(1) Problems encountered in obtaining the necessary information from SSA/DO shall be referred to the DFD.

(2) Disbursements of SSI funds to which a client is entitled, however, shall not be delayed due to non-receipt of Form SSA-(L)8125.

2. Form WFNJ/GA-31, Repayment of Interim Assistance Authorization, delineates distribution of retroactive and initial SSI or initial SSI posteligibility payments and shall be completed and transmitted in accordance with the following provisions:

i. Within 10 working days of the Treasurer's receipt of the SSI award check from SSA, the agency shall deduct any and all Interim Assistance payments provided, in addition to Interim Assistance granted by any other agency which has remitted to the agency by certified mail, a copy of a signed WFNJ/GA-30 form for that client.

(1) Interim Assistance shall only be deducted in accordance with the calendar date on which the client became eligible for SSI, as indicated on Form SSA-(L)8125.

ii. Form WFNJ/GA-31 delineating the computation of the client's net benefit and a check equal to the net SSI benefit due the client, if any, shall be forwarded to the client pursuant to the time frame in (e)2i above.

iii. The client has a right to appeal the computation results in accordance with the provisions of 10:90-9.3.

3. A copy of the completed Form WFNJ/GA-31, together with a copy of the SSA-(L)8125, as received from SSA, shall be forwarded to the DFD immediately following the issuance of Form WFNJ/GA-31 and the net benefit check to the client.

4. In accordance with instructions on Form WFNJ/GA-31 Supplement (Form WFNJ/GA-31 reverse side), a copy of the SSI check shall be attached to Form WFNJ/GA-31 and the WFNJ/GA-31 Supplement completed.

5. The deposit of State share of Interim Assistance recovered shall be deposited into the PATF II Account.

(f) Provisions concerning the installment payments of large retroactive SSI benefits are as follow:

1. Payments will be made directly to the client from SSA in six month intervals, in those instances in which the retroactive SSI benefit exceeds 12 times the monthly SSI entitlement. Any remaining retroactive benefits will be paid in a second installment (not to exceed the first payment amount). All remaining benefits will be paid in a third installment.

i. The county/municipality will be provided with an automated billing form, SSA-L8125-F6 (9/96) "IAR Payment Pending Case-State Due Payment." This billing form will contain a monthly breakdown of the client's payments for the retroactive period and will identify the case as an IAR-Payment Pending Case. The county/municipality shall complete the section entitled, "Amount of reimbursement claimed by the State" using the information provided by SSA in the section entitled, "Retroactive Amount Due Summary." The county/municipality shall be responsible for returning the completed billing form to the SSA field office (FO) servicing the SSI recipient within 10 working days from the date of receipt. The address of the servicing FO will be included on the cover page of the Form SSA-L8125-F6. After the SSA FO receives the completed billing form from the county/municipality, a check shall be issued to the county/municipality in the amount of the reimbursement claimed. The SSA will distribute the remaining SSI installment payments to the recipient.

(g) Rules concerning payment of fees to attorneys or legal entities for successful appeals of claims for SSI benefits are:

1. In order for an attorney or legal entity to be eligible for legal fee payments, the appeal must have been filed on or after September 10, 1996.

2. The funding for the payment of the legal fees will be disbursed from the State's share of the Interim Assistance Reimbursement (IAR) checks. Legal fees shall be paid by DFD and shall be 25 percent of the total retroactive SSI award, provided it does not exceed the amount of the State's share.

3. In order for an attorney/legal entity to receive payment for a successful appeal, the represented individual must have been an active GA recipient sometime during the period covered by the retroactive SSI benefit check.

4. In order for disbursement of fees to be made, legal services providers shall submit the following information to DFD:

i. A petition and copy of the favorable decision within 60 days of the date of receipt of the favorable appeal decision;

ii. An invoice specifying legal services provided;

iii. Proof of the initial and subsequent (if applicable) denial of SSI benefits;

iv. The date of the filing of the appeal;

v. Form WFNJ/GA-31, Repayment of IAR that is provided to the client by the county or municipal agency; and

vi. Form WFNJ/GA-25, Proof of Representation by the Attorney or Legal Entity.

5. If the legal services entity is not an established vendor with the State, then a New Jersey W-9 Form, Request for Taxpayer Identification Number and Certification, should be included with the legal entity's first submittal of an appeal.

6. DFD is required to disburse payment to the legal services provider within 30 days of the date of the submission of the required information.

(h) The Certificate of Authority identifies county/municipal personnel who are authorized to sign documents in conjunction with reporting the receipt and distribution of Interim Assistance Reimbursement received from SSA. The Certificate shall be completed and processed as follows:

1. The names, signatures and titles of the county/municipal agency director and his or her designee(s) (if appropriate) are to be identified on the Certificate;

2. Although the Certificate is to be addressed to the SSA, it is to be mailed to the DFD; and

3. Each new county/municipal director (temporary or full-time) shall complete and submit a Certificate of Authority.

N.J. Admin. Code § 10:90-14.5

Amended by R.1998 d.42, effective 1/20/1998.
See: 29 New Jersey Register 3971(b), 30 New Jersey Register 389(a).
Inserted a new (g); and recodified former (g) as (h).
Amended by R.2003 d.226, effective 6/16/2003.
See: 34 New Jersey Register 2713(a), 35 New Jersey Register 2670(a).
In (c), deleted "in triplicate" preceding "and forwarded to the SSA" in the introductory paragraph; in (e), deleted the second sentence in 2i(1) and deleted "/BBS" following "DFD" in 1iii(1) and 3; in (g), deleted "/BBS" following "DFD" in 2.