<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".54" citation="COMAR 07.03.17.54" title_num="07" subtitle_num="03" chapter_num="17" heading="Establishing a Claim for Overissued or Trafficked Benefits.">
  <paragraph num="A.">
    <text>A recipient claim is an amount owed because of benefits that are:</text>
    <paragraph num="(1)">
      <text>Overpaid; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Trafficked.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The local department shall establish and collect a claim in accordance with this regulation and Regulation .55 of this chapter, regardless of whether the local department meets the timeframe described in §I(1) of this regulation.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The following individuals are responsible for paying a claim:</text>
    <paragraph num="(1)">
      <text>Any individual who was an adult member of the household when the overpayment or trafficking occurred;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A sponsor of an immigrant household member if the sponsor was at fault; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An individual connected to the household, such as an authorized representative, who actually trafficked or otherwise caused an overpayment.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The local department shall establish a claim against a household that has received more Program benefits than it was entitled to receive, except when the overissuance occurred because the:</text>
    <paragraph num="(1)">
      <text>Local department failed to ensure that the household:</text>
      <paragraph num="(a)">
        <text>Signed the application form,</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Completed a current work registration form, or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Was certified in the correct local department area; or</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Local department discovered the administrative error or inadvertent household error that caused the overissuance more than 12 months after the month of the occurrence.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The local department shall categorize claims as an:</text>
    <paragraph num="(1)">
      <text>Administrative error (AE);</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Inadvertent household error (IHE); or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Intentional program violation (IPV).</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Beginning with the date of the discovery of the overissuance, the local department shall include in its calculation of the amount of overissuance any issuance for the:</text>
    <paragraph num="(1)">
      <text>12 preceding months, in the case of an AE or an IHE; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>6 preceding years, in the case of an IPV.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Calculating the Amount of a Claim not Related to Trafficking.</text>
    <paragraph num="(1)">
      <text>The local department shall determine the correct allotment that the household was entitled to receive in each month in the periods described in §E of this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The overissued amount is the difference between the allotment the household received and the amount it would have received if information had been known and acted on in a timely manner.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The earned income deduction as set forth in Regulation .32 of this chapter is not applied when determining an overissuance due to the failure of a household to report earned income in a timely manner.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The first month of the overissuance:</text>
      <paragraph num="(a)">
        <text>Is the month:</text>
        <paragraph num="(i)">
          <text>In which the change in allotment would have been effective had it been reported; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The local department should have effected a change in the allotment had it acted in a timely manner; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>May not be later than 2 months from the month in which the change in household circumstances occurred.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Trafficking Related Claims. A claim arising from a trafficking related offense is the value of the trafficked benefit as determined by:</text>
    <paragraph num="(1)">
      <text>The individual's admission;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Adjudication; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The documentation that forms the basis for the trafficking determination.</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>The local department:</text>
    <paragraph num="(1)">
      <text>Shall establish a claim before the last day of the quarter following the quarter in which the:</text>
      <paragraph num="(a)">
        <text>Overpayment was discovered; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Trafficking incident was determined as described in §G of this regulation; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Need not establish a claim if the claim referral is $125 or less, unless:</text>
      <paragraph num="(a)">
        <text>The household is currently participating in the Program; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The claim was established in a quality control review.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>Claim Processing. The local department shall initiate collection on all established claims unless the claim is collected through an offset of benefits not yet restored as required in Regulation .53 of this chapter.</text>
  </paragraph>
  <paragraph num="K.">
    <text>The local department shall initiate collection action by sending a demand letter to the household which contains language stating:</text>
    <paragraph num="(1)">
      <text>The amount owed;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The reason for the claim;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The period the claim covers;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Any offsetting that was done to reduce the claim;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The methods available to the household for repaying the claim;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The household's right to a fair hearing, if the household disagrees with the amount of the claim;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Notice of the availability of free legal representation;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>The length of time the household has to respond to the letter by returning the signed copy;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>That allotment reduction shall be initiated if a participating household fails to make restitution, and the methods to be used in allotment reduction;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>That the local department may reduce the claim if the local department believes the household is not able to repay the claim;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>That if the claim is not paid, the local department may:</text>
      <paragraph num="(a)">
        <text>Send the claim to other collection agencies; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Refer the claim to the federal government for federal collection action;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>How the claim was calculated; and</text>
    </paragraph>
    <paragraph num="(13)">
      <text>That if the claim becomes delinquent as described in Regulation .55E of this chapter, the household may be subject to additional claim processing fees.</text>
    </paragraph>
  </paragraph>
  <paragraph num="L.">
    <text>Repayment Agreements. A repayment agreement for a claim shall:</text>
    <paragraph num="(1)">
      <text>Include due dates for repayment or time frames for the submission of payments; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Specify that the household will be subject to involuntary collection action if the payment is not received by the due date and the claim becomes delinquent as described in Regulation .55E of this chapter.</text>
    </paragraph>
  </paragraph>
</regulation>