| ASSET | REIMBURSEMENT REQUIRED OF ASSISTANCE RECEIVED ON AND AFTER THE FIRST PAYMENT DAY FOLLOWING | REIMBURSEMENT NOT REQUIRED | ACKNOWLEDG- MENT OF LIABILITY |
| _______________________________________________________________________________________________ |
| REAL PROPERTY |
| _______________________________________________________________________________________________ |
| Burial Plots |
| Owned as an investment | Date acquired | If not owned as an investment but used or planned for use for family burials. | Refer to Area Office |
| _______________________________________________________________________________________________ |
| Damages |
| Moneys received from fire insurance and condemnation awards, etc. | Date original property was acquired. | From funds held in escrow to replace property or to repair damages and used for replacement. | Refer to Area Office on PA 173-S (§§ 257.24(g), 257.24(b)(5)(ix)). |
| _______________________________________________________________________________________________ |
| Houses on Leased Land | Date acquired | Refer to Area Office (§ 257.24(c)(1)). |
| _______________________________________________________________________________________________ |
| Property Purchased with Proceeds of Veterans' Bonus | Date acquired | From that part of the sales price equal to the amount of the bonus invested. | PA 9 (§ 257.24(b)(1)) |
| _______________________________________________________________________________________________ |
| Real Estate |
| Examples: Resident or nonresident property, surface and subsurface rights, together with the funds acquired from the lease, sale or other conversion of the asset. | Date interest in real estate was acquired or right of action existed from which property resulted. (§257.24(h)) | From income resulting from transactions that do not deplete the property, e.g., rent or income from farming timber (income from the sale of timber, which has been cut selectively or replaced so that the total timber resources are not depleted). | PA 9 (§ 257.24(b)(1)) |
| _______________________________________________________________________________________________ |
| Trailer Homes | Date acquired | Refer to Area Office on PA 173-S |
| _______________________________________________________________________________________________ |
| _______________________________________________________________________________________________ |
| REAL PROPERTY |
| _______________________________________________________________________________________________ |
| Alimony Payments | Normal payment date | If paid before first payment day after normal due date. | PA 176-K *Delayed (specify) payments. |
| _______________________________________________________________________________________________ |
| Asset Formerly Owned but not Legally Claimable (Old Debts, Returned Gifts, Etc.) | Date acquired | Refer to Area Office on PA 173-S. |
| _______________________________________________________________________________________________ |
| Black Lung Benefits | First day of first month following the month of entitlement. | If paid before first payment day after normal due date. | PA 176-K *Delayed (or retroactive) Black Lung Benefits. |
| _______________________________________________________________________________________________ |
| Christmas Savings Funds | Date acquired | Assignment, Refer to Area Office on PA 173-S. |
| _______________________________________________________________________________________________ |
| Delayed Wages | Normal payment date | PA 176-K *Delayed Wages due from (specify). |
| _______________________________________________________________________________________________ |
| Other Delayed Payments | Normal payment date | Assignment. Refer to Area Office on PA 173-S. |
| _______________________________________________________________________________________________ |
| Estates of Deceased Recipients | Date originally acquired | Refer to Area Office PA 176-S. |
| _______________________________________________________________________________________________ |
| Goods, Chattels, Autos and Antiques | From date conversion into cash was required | Unless assistance was granted pending conversion into cash. | PA 176-K *Cash from the sale of (specify). |
| _______________________________________________________________________________________________ |
| *Insert phrase on PA 176-K |
| ASSET | REIMBURSEMENT REQUIRED OF ASSISTANCE RECEIVED ON AND AFTER THE FIRST PAYMENT DAY FOLLOWING | REIMBURSEMENT NOT REQUIRED | ACKNOWLEDG- MENT OF LIABILITY |
| _______________________________________________________________________________________________ |
| Inheritances by Living Recipients | Date of death of the person who owned the property. | PA 198-S and PA 9 (§ 257.24(c)(2)(iii)). |
| _______________________________________________________________________________________________ |
| Leases of Oil, Gas and Mineral Rights | Date right to asset was acquired; not date lease was given. | Assignment. Refer to Area Office. |
| _______________________________________________________________________________________________ |
| Life Insurance Cash from adjustment not used for burial reserve. | Date adjustment was required (§ 177.31) (relating to resource limit) | PA 176-K *Cash from Insurance adjustment. |
| _______________________________________________________________________________________________ |
| Paid to beneficiary | Date of insured's death but only if payment is delayed. | If benefits are paid promptly. Reimbursement is not required from that part of the resource used to pay burial or last medical expense. | Assignment. Refer to Area Office. |
| _______________________________________________________________________________________________ |
| Policies assigned to the Department. | Date adjustment was required (§ 177.31). Limited to death benefits and payment of the face amount while living. | From disability and dividend payments and from exemption not exceeding $500 from all insurance. See § 177.31. | Assignment on insurance company's form or PA 6-F (§ 257.24(e)(5)). |
| _______________________________________________________________________________________________ |
| Policies not assigned to the Department. | Date adjustment was required (§ 177.31) but only if policy should have been assigned. | Unless policy should have been assigned. | Refer to Area Office on PA 173-S. |
| _______________________________________________________________________________________________ |
| Lottery Winnings | Date won. | Refer to Area Office on PA 173-S. |
| _______________________________________________________________________________________________ |
| Mortgages, Judgments, Trust Funds, Leases, Options, Etc. | Date acquired | Assignment. Send memorandum to Area Office to prepare assignments. |
| _______________________________________________________________________________________________ |
| *Insert phrase on PA 176-K |
| ASSET | REIMBURSEMENT REQUIRED OF ASSISTANCE RECEIVED ON AND AFTER THE FIRST PAYMENT DAY FOLLOWING | REIMBURSEMENT NOT REQUIRED | ACKNOWLEDG- MENT OF LIABILITY |
| _______________________________________________________________________________________________ |
| Railroad Retirement Benefits |
| Single final payment | Normal payment date | If paid before first payment day after normal due date. | PA 176-K *Delayed (or retroactive) Railroad Retirement Benefits. |
| Periodic payments | Normal payment date (fourth day of second month following month of entitlement) | If paid before first payment day after normal due date. | PA 176-K *Delayed (or retroactive) Railroad Retirement Benefits. |
| _______________________________________________________________________________________________ |
| Personal Damage Claims and Awards A claim resulting from injuries to a person. | Date of injury, but no earlier than 9-26-51 when Support Law was amended. Only exception is award made prior to 9-26-51 and being contested; due date is then date of original award. When an award is made to a minor reimbursement required only for assistance to or for minor; if to an adult, calculate in usual way.If a guardian is appointed, a parent's signature is no longer a condition of eligibility. The guardian is asked to sign the 176-K, and if a refusal is encountered, a referral is made promptly to the Claim Settlement Area. | From that part of the award paid for necessary burial and medical costs arising from injury and no otherwise paid, and cost of collecting the damages. | Obtain PA 176-K (*pending recovery of damages) and send to Area Office with memorandum in duplicate summarizing situation and giving names of attorneys, plaintiff, defendant, insurance company, etc. |
| _______________________________________________________________________________________________ |
| *Insert phrase on PA 176-K |
| ASSET | REIMBURSEMENT REQUIRED OF ASSISTANCE RECEIVED ON AND AFTER THE FIRST PAYMENT DAY FOLLOWING | REIMBURSEMENT NOT REQUIRED | ACKNOWLEDG- MENT OF LIABILITY |
| _______________________________________________________________________________________________ |
| Personal Property Damages Moneys received from fire insurance, compensation for destruction, etc., on reimbursable property. | Date original property was acquired. | From funds held in escrow for replacement of damaged property and used for replacement and for costs of collection. | Obtain PA 176-K (*pending recovery of damages) and send to Area Office with memorandum in duplicate summarizing situation and giving names of persons and firms involved. |
| _______________________________________________________________________________________________ |
| Public Charge Bond (Aliens only. Does not apply to Displaced Persons.) | Date of entry into the country, for a period of 5 years. | If sponsor was not required by Federal authorities to file a bond as a condition for admission of the alien into this country. | Refer to Area Office on PA 173-S. |
| _______________________________________________________________________________________________ |
| Railroad Unemployment Benefits Periodic payments | Normal payment date (10th day after end of each registration period). | If paid before first payment day after normal due date. | PA 176-K *Delayed (or retroactive) benefits due under the Railroad Retirement Act. |
| _______________________________________________________________________________________________ |
| Rent Refunds | Date of overpayment | Refer to Area Office on PA 173-S. |
| _______________________________________________________________________________________________ |
| Retirement Funds Which May Be Withdrawn in One Payment | Date conversion into cash was required | Unless assistance was granted pending conversion into cash. | PA 176-K *Retire ment benefits due from (specify) |
| _______________________________________________________________________________________________ |
| Social Security Retirement, Survivor's and Disability Income Benefits (RSDI) | Normal payment date | If paid before first payment day after normal due date | PA 176-K* Delayed or retroactive social security retirement, survivor's or disability income benefits. |
| _______________________________________________________________________________________________ |
| *Insert phrase on PA 176-K |
| ASSET | REIMBURSEMENT REQUIRED OF ASSISTANCE RECEIVED ON AND AFTER THE FIRST PAYMENT DAY FOLLOWING | REIMBURSEMENT NOT REQUIRED | ACKNOWLEDG- MENT OF LIABILITY |
| _______________________________________________________________________________________________ |
| State Employees Retirement System Benefits |
| Single final payment | Normal payment date (6 weeks from date of separation) | If paid before first payment day after normal due date. | PA 176-K *Delayed (or retroactive) State Employees Retirement System. |
| _______________________________________________________________________________________________ |
| State Employees Retirement System Benefits Periodic payments | Normal payment date (6 weeks from effective date or retirement) | If paid before first payment day after normal due date. | PA 176-K *Delayed (or retroactive) State Employees Retirement System. |
| Paid to beneficiary death | Normal payment date (7 weeks from date of employe's death) | If paid before first payment day after normal due date. Reimbursement is not required from that part of the resource used to pay burial or last medical expense. | PA 176-K *Delayed benefit State Employees Retirement System. |
| _______________________________________________________________________________________________ |
| SSI-Supplemental Security Income | Normal payment date. | If paid before the first payment day after normal due date. | PA 176-K for AFDC *Delayed (or retroactive) benefits SSI. 176-S for GA SBP. |
| _______________________________________________________________________________________________ |
| Other Federal Benefits and Pensions | Normal payment date. | If paid before first payment day after normal due date. | PA 176-K *Delayed payment day after (or retroactive benefits due from (specify) |
| _______________________________________________________________________________________________ |
| Other Retirement Benefits and Pensions | Normal payment date. | If paid before first payment day after normal due date. | PA 176-K *Delayed (or retroactive) benefits due from (specify) |
| _______________________________________________________________________________________________ |
| *Insert phrase on PA 176-K |
| ASSET | REIMBURSEMENT REQUIRED OF ASSISTANCE RECEIVED ON AND AFTER THE FIRST PAYMENT DAY FOLLOWING | REIMBURSEMENT NOT REQUIRED | ACKNOWLEDG- MENT OF LIABILITY |
| _______________________________________________________________________________________________ |
| Sick Benefits All kinds | Normal payment date. | From that part of benefits paid for necessary medical and burial costs arising from the illness and not otherwise paid and costs of collecting the benefits. | PA 176-K *Delayed sick benefits |
| _______________________________________________________________________________________________ |
| Soldiers' Allotments | Normal payment date. | If paid before first payment day after normal due date. | PA 176-K *Allotment from (specify) |
| _______________________________________________________________________________________________ |
| Stocks, Bonds B L Shares Not Immediately Saleable | Date acquired | Assignment on certificate ownership ( 257.24(e)(6)) |
| _______________________________________________________________________________________________ |
| Support Order Payments |
| Orders payable to recipient | Normal payment date | If paid before first payment day after normal due date. | PA 176-K *Delayed support payments. |
| Orders payable to Department | As ordered by the court | Refer to Area Office on 173-S |
| _______________________________________________________________________________________________ |
| UMWA Welfare Fund Benefits |
| Initial payments | Under any circumstances |
| Suspended payments -payments for a period during which the Fund suspended payments and which are later paid retroactively | The beginning of the suspension | If retroactive benefits are not paid. | PA 176-K *Suspend- ed benefits from the UMWA Health, Welfare and Retirement Fund |
| _______________________________________________________________________________________________ |
| Unemployment Compensation |
| Pennsylvania employment | Normal payment date (7 days after reporting day). | If paid before first payment date after normal due date. | PA 176-U (See § 257.24(e)(2)). |
| _______________________________________________________________________________________________ |
| *Insert phrase on PA 176-K |
| ASSET | REIMBURSEMENT REQUIRED OF ASSISTANCE RECEIVED ON AND AFTER THE FIRST PAYMENT DAY FOLLOWING | REIMBURSEMENT NOT REQUIRED | ACKNOWLEDG- MENT OF LIABILITY |
| _______________________________________________________________________________________________ |
| Out-of-State employment, Federal Employee and Veterans Unemployment Compensation | Normal payment date (7 days after reporting day. See § 225.11. | If paid before first payment day after normal due date. | PA 176-K *Delayed Unemployment Compensation (Out- of-State or Federal Employee or Veterans) |
| _______________________________________________________________________________________________ |
| Unsecured Claims, Unsecured Loans Due Applicant/recipient | Date acquired | Unless assistance was granted pending conversion into cash | Assignment if possible, otherwise PA 176-K Money due me from (specify) (§ 257.-24(i)(1)) |
| _______________________________________________________________________________________________ |
| Veterans Benefits and Pensions | Normal payment date | If paid before first payment day after normal due date | PA 176-K *Delayed (or retroactive) benefits due from (specify) |
| _______________________________________________________________________________________________ |
| Vocational Training Payments | Normal payment day (7 days after the end of the compensable training week). | If paid before first payment date after normal due date. | PA 176-K Enter on form: Delayed (Specify) Training Payments. |
| _______________________________________________________________________________________________ |
| Workmen's Compensation |
| Periodic benefits | Normal payment date (end of 2nd week following injury) | If paid before first payment date after normal due date. | PA 176-K *Delayed Workmen's Compensation Benefits |
| Lump-sum award | Date of injury | From that part of benefits paid for necessary medical and burial costs arising from the illness and not otherwise paid and costs of collecting the benefits. | PA 176-K *Work men's Compensation Benefits |
| _______________________________________________________________________________________________ |
| *Insert phrase on PA 176-K |