[50 Pa.B. 6361]
[Saturday, November 14, 2020]
[Continued from previous Web Page]
ELIGIBILITY REDETERMINATION § 3042.101. Eligibility redetermination.
(a) The eligibility agency shall complete a redetermination of eligibility no less than every 12 months and establish the family's next redetermination date.
(b) Prior to the redetermination, the eligibility agency shall do the following:
(1) Provide the parent or caretaker with the Department's form listing the following information last reported for each parent or caretaker or child in the family:
(i) Earned income.
(ii) Unearned income.
(iii) Hours of work, education or training.
(iv) Family composition.
(v) Address.
(2) Request that the parent or caretaker verify the family's current income.
(3) Verify the following factors only if the parent or caretaker reports a change:
(i) Work, education or training.
(ii) The number of hours of work, education or training.
(iii) Family composition.
(iv) Address.
(c) The parent or caretaker's annual income must meet the requirements set forth in § 3042.31(c) (relating to financial eligibility).
§ 3042.102. Procedures for redetermination.
(a) No earlier than 6 weeks prior to redetermination, the eligibility agency shall send the family a form that lists the factors that will be reviewed for the redetermination of eligibility and explain the verification that will be needed to complete the redetermination.
(b) If the parent or caretaker submits only some of the required verification elements prior to the redetermination, the eligibility agency shall request in writing that the parent or caretaker submit the additional verification no later than the family's redetermination date.
(c) The eligibility agency shall retain a copy of the notification in the family file.
(d) The eligibility agency shall send a written notice to the parent or caretaker regarding failure to provide required verification only after the family's redetermination date.
(e) The eligibility agency shall require the parent or caretaker to complete, sign, and either mail, hand-deliver, fax or electronically submit the applicable form at each redetermination.
FORMER TANF FAMILIES § 3042.111. General provisions for former TANF families.
(a) A family that is no longer eligible for TANF cash assistance benefits or a family that voluntarily left the TANF program and meets the eligibility requirements specified in this chapter may qualify for subsidized child care.
(b) The eligibility agency shall review the information received from the CAO about a parent or caretaker who formerly received TANF benefits.
(c) The eligibility agency shall determine the date TANF benefits ended and establish the 183-day period after eligibility for TANF benefits ends, within which the parent or caretaker may receive child care benefits.
(d) Eligibility for former TANF child care benefits shall begin the day following the date TANF benefits ended and shall continue for 183 consecutive days.
(e) The parent or caretaker may request child care benefits at any time during the 183-day period after eligibility for TANF ended.
(f) The eligibility agency may not place a child on a waiting list if a former TANF parent or caretaker requests subsidized child care for that child any time prior to 184 calendar days after TANF benefits ended.
(g) A family is not eligible for former TANF benefits if a parent or caretaker is currently disqualified from receiving TANF benefits as specified in §§ 255.1(c) and 275.51 (relating to restitution and disqualification policy; and imposing the disqualification).
§ 3042.112. General requirements for former TANF families.
(a) During the 183-day period after eligibility for TANF benefits ended or after a family voluntarily left the TANF program, a parent or caretaker shall meet the following conditions:
(1) A former TANF parent or caretaker who is not transferred to the eligibility agency by the CAO or who applies for subsidized child care during the 183-day period after eligibility for TANF ended shall meet the work requirement as specified in § 3042.33 (relating to work, education and training).
(2) The family's annual income may not exceed 85% SMI.
(3) The parent or caretaker shall select an eligible child care provider as specified in § 3042.12(a) (relating to parent choice).
(4) The parent or caretaker shall make timely payment of the co-payment as specified in § 3042.91 (relating to general co-payment requirements).
(b) A former TANF parent or caretaker who is transferred to the eligibility agency by the CAO or who applies for subsidized child care during the 183-day period after eligibility for TANF ended as specified in subsection (a) shall not be placed on a waiting list.
(c) The eligibility agency shall complete a redetermination of eligibility and establish the family's next redetermination date as specified in § 3042.101(a) (relating to eligibility redetermination).
§ 3042.113. Notification requirements for former TANF families.
(a) If the eligibility agency determines that a parent or caretaker met the requirements in § 3042.112 (relating to general requirements for former TANF families) and was receiving child care on the date TANF benefits ended, the eligibility agency shall notify the parent or caretaker of the family's eligibility status and the date the 183-day former TANF period will expire.
(b) If the eligibility agency determines that a parent or caretaker was not receiving child care or cannot determine whether the parent or caretaker was receiving child care on the date TANF benefits ended, the eligibility agency shall notify the parent or caretaker by letter of the following:
(1) The parent or caretaker may be eligible for child care benefits.
(2) The parent or caretaker may contact the eligibility agency if child care is needed during the 183-day period after TANF benefits ended.
(3) Eligibility for subsidized child care is assured if the minimum requirements specified in § 3042.112(a) are met.
§ 3042.114. Face-to-face requirements for former TANF families.
(a) When the parent or caretaker contacts the eligibility agency within 183 days after TANF benefits end, the eligibility agency shall inform the parent or caretaker of the requirement to attend a face-to-face meeting with the eligibility agency. The face-to-face meeting shall occur no later than 30 calendar days following the date of the letter unless, on or before the 30th day, the parent or caretaker claims hardship. At the time the parent or caretaker claims hardship, the eligibility agency may grant an additional 30 days from the date the hardship is claimed for the meeting.
(b) When the parent or caretaker contacts the eligibility agency in response to the letter specified in § 3042.113(b) (relating to notification requirements for former TANF families), the eligibility agency shall schedule a face-to-face meeting with the parent or caretaker. The eligibility agency may substitute a telephone contact for a face-to-face meeting if a face-to-face meeting would cause a hardship for the parent or caretaker.
(c) To maintain continuous child care payment from the day following the date TANF benefits ended, the parent or caretaker shall attend a face-to-face meeting or participate in a telephone contact with the eligibility agency as specified in § 3042.115 (relating to reporting requirements for former TANF families).
(d) The eligibility agency may waive the requirement for the face-to-face meeting if the parent or caretaker has completed a face-to-face meeting with the eligibility agency within the previous 12 months.
§ 3042.115. Reporting requirements for former TANF families.
Either at the time of the parent's or caretaker's face-to-face meeting with the eligibility agency and within the 183-day period after TANF benefits ended or at the time of telephone contact by the eligibility agency with the parent or caretaker and within the 183-day period after TANF benefits ended, the eligibility agency shall:
(1) Require the parent or caretaker who contacts the eligibility agency within 60 calendar days following the date TANF benefits ended to self-certify the following information that was electronically transferred by the CAO:
(i) The need for child care to work or attend education or training and the days and hours for which the child needs care.
(ii) The name of the employer, education or training.
(iii) The hours the parent or caretaker works or attends education or training.
(iv) The accuracy of the facts in the TANF transfer information regarding family address, size and income.
(v) Financial eligibility as specified in § 3042.112(a) (relating to general requirements for former TANF families).
(2) Require the parent or caretaker whose information was unavailable or has changed since the time of the electronic transfer to self-declare the information that was unavailable or has changed.
(3) Require the parent or caretaker who does not contact the eligibility agency within 60 calendar days following the date TANF benefits ended to self-declare the following:
(i) The need for child care to work or attend education or training and the days and hours for which the child needs care.
(ii) The name of the employer, education or training.
(iii) The hours the parent or caretaker works or attends education or training.
(iv) The accuracy of the facts in the TANF transfer information regarding family address, size and income.
(v) Financial eligibility as specified in § 3042.112(a).
(4) Advise the parent or caretaker to report income in excess of 85% of the SMI.
(5) The eligibility agency shall require a parent or caretaker to complete a subsidized child care application under the following circumstances:
(i) The parent or caretaker received TANF benefits in another state.
(ii) The CAO did not have sufficient information to electronically transfer to establish a case file.
(6) Advise the parent or caretaker that the eligibility agency shall complete an eligibility determination or redetermination.
(7) Collect information regarding the parent's or caretaker's choice of provider or help the parent or caretaker to locate an eligible provider.
§ 3042.116. Verification of transfer of TANF benefits.
Documentation by the eligibility agency that indicates the date TANF benefits ended within the State or in another state, as specified in § 3042.120(b) (relating to transfer from other states), is acceptable verification of transfer of TANF benefits within the State or from another state.
§ 3042.117. Failure to contact the eligibility agency following transfer.
(a) If a parent or caretaker who was receiving child care on the date TANF benefits ended fails to contact the eligibility agency in response to the letter specified in § 3042.113(a) (relating to notification requirements for former TANF families), the eligibility agency shall contact the parent or caretaker by telephone no later than 31 calendar days following the date of the letter.
(b) When the eligibility agency contacts the parent or caretaker as specified in subsection (a), the eligibility agency shall determine the following:
(1) The parent's or caretaker's choice to meet the contact requirement using a telephone contact or participating in a face-to-face meeting.
(2) The parent's or caretaker's continuing need for child care.
(c) If the eligibility agency determines that the parent or caretaker was not receiving child care or cannot determine whether the parent or caretaker was receiving child care on the date TANF benefits ended, the eligibility agency may not authorize payment for child care benefits until the date the parent or caretaker contacts the eligibility agency and requests benefits.
(d) If a parent or caretaker who was receiving child care on the date TANF benefits ended does not attend a face-to-face meeting as specified in § 3042.114(a) (relating to face-to-face requirements for former TANF families), the eligibility agency shall contact the parent or caretaker by telephone no later than the day following the date the parent or caretaker failed to attend the face-to-face meeting to determine the information specified in subsection (b).
§ 3042.118. Payment authorization for former TANF families.
(a) The eligibility agency shall review a request from a parent or caretaker to authorize child care payment at any time during the 183-day period after eligibility for TANF benefits ended.
(b) The eligibility agency shall authorize child care payment at any time during the 183-day period after eligibility for TANF ended.
(c) The eligibility agency may not pay child care costs that exceed the maximum child care allowance minus the family co-payment for the type of care the child received from the provider.
§ 3042.119. Retroactive payment for former TANF families.
(a) If the eligibility agency authorizes payment to an eligible provider that is currently participating in the subsidized child care program for a parent or caretaker who was receiving child care on the date TANF benefits ended, the authorization is retroactive to the day following the date TANF benefits ended.
(b) If the eligibility agency determines that the parent or caretaker was not receiving child care or cannot determine whether the parent or caretaker was receiv- ing child care on the date TANF benefits ended, the eligibility agency shall require the parent or caretaker to submit verification of child care costs incurred during the 183-day period after eligibility for TANF ended.
(c) The eligibility agency shall authorize payment to an eligible provider that is currently participating in the subsidized child care program for the parent or caretaker specified in subsection (b) retroactive to the date the parent or caretaker first incurred child care expenses.
(d) If the eligibility agency determines that the parent or caretaker has selected an ineligible provider, it shall inform the parent or caretaker that the parent or caretaker shall contact the eligibility agency to discuss child care arrangements within 30 calendar days as specified in § 3042.12 (relating to parent choice).
§ 3042.120. Transfer from other states.
(a) A parent or caretaker who received TANF program benefits in another state and applies for subsidized child care is eligible if the parent or caretaker meets the following conditions:
(1) The parent or caretaker applies within 183 days after TANF benefits ended.
(2) The parent or caretaker meets the requirements specified in § 3042.112 (relating to general requirements for former TANF families).
(b) The eligibility agency shall determine the date TANF benefits ended in the other state and establish eligibility for the 183-day period after eligibility for TANF ended as specified in § 3042.111 (relating to general provisions for former TANF families).
§ 3042.121. Expiration of TANF benefits.
(a) A parent or caretaker who was receiving child care on the date TANF benefits ended and who has exhausted the 5-year limit on TANF benefits is eligible for up to 92 calendar days of subsidized child care to seek work.
(b) The eligibility agency shall determine the date TANF benefits ended and establish the period of former TANF eligibility as specified in § 3042.111 (relating to general provisions for former TANF families).
(c) The parent or caretaker may apply at any time during the 183-day period after eligibility for TANF ended.
(d) The maximum period of potential eligibility for former TANF child care benefits under this section is 183 days.
§ 3042.122. Verification of expiration of TANF benefits.
Documentation by the eligibility agency that indicates the date TANF benefits expired within the State or in another state, as specified in § 3042.121(b) (relating to expiration of TANF benefits), is acceptable verification of expiration of TANF benefits.
HEAD START § 3042.131. General provisions for Head Start.
(a) A child who is enrolled in a Head Start program, whose parent or caretaker needs extended hours or days of child care beyond the hours or days provided by the Head Start program to work, is eligible for subsidized child care under this section if the parent or caretaker meets the eligibility requirements for subsidized child care as specified in subsection (d) each time a child in the family applies for Head Start special eligibility.
(b) The eligibility agency shall verify with the Head Start program that the child is enrolled in a Head Start program that meets Federal and State Head Start standards.
(c) If a child in the family as specified in § 3042.41 (relating to family size) is enrolled in the Head Start program, the family co-payment is based on family size and income. If additional children in the family are enrolled in subsidized child care, the family co-payment is based on family size and income.
(d) If extended hours or days of care are provided beyond the Head Start program hours or days, a facility that has a certificate of compliance by the Department as a child care facility shall provide the extended hours and days of care.
§ 3042.132. Eligibility determination for Head Start.
Upon program entry and continuation in the Head Start special eligibility program, a parent or caretaker shall meet the following conditions:
(1) Verification of a minimum of 20 hours of work per week as specified in § 3042.33 (relating to work, education and training) each time a parent or caretaker applies for a child in the family for the Head Start special eligibility program.
(2) Verification that extended hours and days of child care are needed to work as specified in § 3042.131(a) (relating to general provisions for Head Start).
(3) Verification of income eligibility for subsidized child care as specified in § 3042.31 (relating to financial eligibility) each time a parent or caretaker applies for a child in the family for the Head Start program.
(4) Compliance with the waiting list conditions specified in § 3042.57 (relating to waiting list).
(5) Payment of the co-payment as specified in § 3042.91 (relating to general co-payment requirements).
(6) Report when a child is no longer enrolled in Head Start within 10 calendar days following the date the Head Start enrollment ended.
§ 3042.133. Eligibility redetermination for Head Start.
(a) The eligibility agency may not complete a redetermination prior to the expiration of the 12-month eligibility period as specified in § 3042.101(a) (relating to eligibility redetermination) upon receiving notification that a child is no longer enrolled in a Head Start program.
(b) The eligibility agency shall conduct a redetermination when the child is no longer enrolled in the Head Start program, if the 12-month redetermination period has expired as specified in § 3042.101(a).
(c) The eligibility agency shall conduct a redetermination as specified in § 3042.101 if the family has additional children who are not enrolled in Head Start but receive subsidized child care. A family that includes a child enrolled in a Head Start program and a child who is not enrolled in a Head Start program is subject to redetermination requirements as specified in § 3042.101(a).
(d) Eligibility for a child enrolled in a Head Start program is unrelated to the eligibility of other children in the family who are not enrolled in a Head Start program and receive subsidized child care. Eligibility for a child enrolled in a Head Start program shall continue as specified in this section.
(e) The eligibility agency shall conduct a redetermination between the time a child is no longer enrolled in Early Head Start and the time the child enters Head Start, with the exception of the requirement set forth in subsection (a).
WAIVERS AND PERIODS OF
PRESUMPTIVE ELIGIBILITY§ 3042.141. Domestic and other violence.
(a) The eligibility agency may grant a waiver to a parent or caretaker for the following reasons:
(1) A family member is the victim of past or present domestic or other violence.
(2) A family member is the victim of a threat of past or present domestic or other violence.
(b) The eligibility agency may grant a waiver if compliance with a requirement of this chapter would either make it more difficult for a family or household member to escape domestic violence or place a family or household member at risk of domestic violence.
(c) The following requirements of this chapter may not be waived:
(1) Age of the child as specified in § 3042.11(b) and (c) (relating to provision of subsidized child care).
(2) Income limits as specified in § 3042.31 (relating to financial eligibility).
(3) State residency as specified in § 3042.32 (relating to residence).
(4) The minimum number of hours of work, education or training as specified in § 3042.33 (relating to work, education and training).
(5) Citizenship as specified in § 3042.36 (relating to citizenship).
(6) The number of paid absences as specified in § 3042.18 (relating to absence).
(d) The following may be waived, not to exceed 92 days:
(1) Verification requirements as specified in §§ 3042.61—3042.74 regarding self-certification and verification.
(2) The amount of co-payment as specified in § 3042.98 (relating to co-payment determination).
§ 3042.142. Homelessness.
(a) The eligibility agency may grant a waiver to a parent or caretaker who is experiencing homelessness as defined in § 3042.3 (relating to definitions).
(b) The following requirements of this chapter may not be waived:
(1) Age of the child as specified in § 3042.11(b) and (c) (relating to provision of subsidized child care).
(2) Income limits as specified in § 3042.31 (relating to financial eligibility).
(3) State residency as specified in § 3042.32 (relating to residence).
(4) Citizenship as specified in § 3042.36 (relating to citizenship).
(5) The number of paid absences as specified in § 3042.18 (relating to absences).
(c) The following may be waived, not to exceed 92 days:
(1) Verification requirements as specified in §§ 3042.61—3042.73 regarding self-certification and verification.
(2) The amount of the co-payment as specified in § 3042.98 (regarding to co-payment determination).
(d) At the time of application or redetermination, the eligibility agency may grant a period of presumptive eligibility to a parent or caretaker who is experiencing homelessness.
(e) At the end of the 92-day period, the eligibility agency will complete a full redetermination to establish the 12-month eligibility period and reset the redetermination due date.
§ 3042.143. Leave periods at redetermination.
(a) The eligibility agency may grant a period of presumptive eligibility, as defined in § 3042.3 (relating to definitions), in the following circumstances:
(1) Maternity or family leave as defined under the Family and Medical Leave Act of 1993 (29 U.S.C.A. §§ 2601—2654).
(2) Experiences the onset of a disability that is verified as specified in § 3042.70 (relating to verification of inability to work due to a disability).
(3) A parent or caretaker has a break in work, education or training that does not exceed 92 days.
(b) Upon expiration of the period of presumptive eligibility granted as specified in subsection (a), the parent or caretaker shall submit verification that the parent or caretaker has work, education or training that meets the work-hour requirement as specified in § 3042.33 (relating to work, education and training).
(c) At the end of the 92-day period, the eligibility agency will complete a full redetermination to establish the 12-month eligibility period and reset the redetermination due date.
§ 3042.144. General waiver requirements.
The eligibility agency may grant a waiver to a family experiencing domestic violence or homelessness upon the request of the parent or caretaker as specified in §§ 3042.141 and 3042.142 (relating to domestic and other violence; and homelessness).
§ 3042.145. Time frame for waiver determinations.
The eligibility agency shall act on a parent's or caretaker's waiver request no later than 15 calendar days following the date the parent or caretaker requests the waiver.
§ 3042.146. General verification requirements for waivers.
The Department's form that provides for verification by documentary evidence, third party statement or self-certification is acceptable verification of domestic violence or homelessness.
§ 3042.147. General notification requirements for waivers.
(a) The eligibility agency shall provide written notice to the parent or caretaker regarding the eligibility agency's determination to grant or deny a waiver request. At the request of the parent or caretaker, the eligibility agency shall mail the notice to an alternate address or hand-deliver it to the parent or caretaker.
(b) If the eligibility agency grants the waiver, the notice must include the basis for granting the waiver.
(c) If the eligibility agency denies the waiver, the notice must include the following:
(1) The basis for the denial.
(2) The right to appeal the decision and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
(3) The verification the parent or caretaker shall submit for the eligibility agency to grant the waiver and the time frames in which the parent or caretaker shall submit the verification.
(4) The evidence or information needed to substantiate the waiver request and the time frames in which the parent or caretaker shall provide the information.
NOTIFICATION AND RIGHT TO APPEAL § 3042.151. General notification requirements.
(a) The eligibility agency shall notify the parent or caretaker in writing no later than 10 calendar days prior to taking an action that affects the family's eligibility status for subsidized child care or a change in the amount of the family's subsidized child care benefit.
(b) Following the preparation of a written notice, the eligibility agency shall:
(1) Mail or hand-deliver, within 1 working day of preparation, the original and one copy of the notice to the parent or caretaker.
(2) Notify the family's child care provider as soon as the family is determined eligible or ineligible for subsidized child care.
(3) Retain a copy of the notice in the family file as specified in § 3042.84 (relating to family file).
§ 3042.152. Notice of right to appeal.
The following information must be included in the notice of the right to appeal:
(1) The statement regarding the parent's or caretaker's right to appeal.
(2) The time frame associated with filing a timely appeal as specified in §§ 3042.164(d) and 3042.166(b) (relating to parent or caretaker rights and responsibilities regarding appeal; and hearing procedures).
(3) The time frame associated with subsidy continuation as specified in § 3042.163 (relating to subsidy continuation during the appeal process).
(4) The consequence of filing an appeal untimely.
(5) The responsibility to repay if subsidy continues and the parent or caretaker does not win the appeal.
(6) Instructions regarding how to appeal.
§ 3042.153. Notice of eligibility.
(a) The notice of eligibility must be on a form provided by the Department.
(b) If the eligibility agency determines a family eligible for subsidy upon initial application, at the time of redetermination or at a review of a reported change, the written notification must include the following:
(1) The amount of the co-payment.
(2) The parent's or caretaker's responsibility to pay the co-payment as specified in § 3042.91(e) (relating to general co-payment requirements).
(3) The parent's or caretaker's responsibility to report changes as specified in § 3042.86 (relating to processing reported changes).
(4) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
(5) The right of the parent or caretaker to appeal the decision and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
§ 3042.154. Notice of ineligibility.
(a) The notice of ineligibility must be on a form provided by the Department.
(b) If the eligibility agency determines a family ineligible for subsidy, the written notification must include the following:
(1) The decision.
(2) The reason for the decision.
(3) A citation, and brief explanation in simple, nontechnical language, of the applicable section of this chapter or other applicable law that was the basis for the decision.
(4) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
(5) The right of the parent or caretaker to appeal the decision and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
§ 3042.155. Notice of adverse action.
(a) The eligibility agency shall send a notice to a parent or caretaker currently receiving subsidy when the eligibility agency proposes to terminate subsidy payment.
(b) The eligibility agency shall prepare a notice of adverse action on a form provided by the Department.
(c) The notice of adverse action must include:
(1) The decision or proposed action.
(2) The date the action will occur.
(3) The reason for the decision or proposed action and information about how to become eligible.
(4) A citation, and brief explanation in simple, nontechnical language, of the applicable section of this chapter or other applicable law that is the basis for the decision or proposed action.
(5) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
(6) The right of the parent or caretaker to appeal the decision and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
§ 3042.156. Notice confirming voluntary withdrawal.
(a) The eligibility agency shall, by written notice to the parent or caretaker, confirm the parent's or caretaker's voluntary withdrawal of a child from subsidized child care.
(b) The notice confirming voluntary withdrawal must be on a form provided by the Department.
(c) The written notice confirming voluntary withdrawal must include the following:
(1) The decision.
(2) The reason for the decision.
(3) A citation, and brief explanation in simple, nontechnical language, of the applicable section of this chapter or other applicable law that was the basis for the decision.
(4) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
(5) The right of the parent or caretaker to appeal the decision and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
§ 3042.157. Notice confirming a change in benefits.
(a) The eligibility agency shall, by written notice to the parent or caretaker, confirm a change in the parent's or caretaker's subsidized child care benefits when the change does not affect the family's eligibility. Changes in benefits include a change in the number of days or hours during which the child is enrolled, subsidy suspension and subsidy disruption.
(b) The notice confirming a change in benefits must be on a form provided by the Department.
(c) The written notice confirming a change in benefits must include the following:
(1) The decision.
(2) The reason for the decision.
(3) A citation, and brief explanation in simple, nontechnical language, of the applicable section of this chapter or other applicable law that was the basis for the decision.
(4) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
(5) The right of the parent or caretaker to appeal the decision and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
§ 3042.158. Notice confirming a change in co-payment.
(a) The eligibility agency shall, by written notice to the parent or caretaker, confirm a change in the family co-payment amount.
(b) The notice confirming a change in co-payment must be on a form provided by the Department.
(c) The written notice confirming a change in co-payment must include the following:
(1) The decision.
(2) The reason for the decision.
(3) A citation, and brief explanation in simple, nontechnical language, of the applicable section of this chapter or other applicable law that was the basis for the decision.
(4) The amount of the co-payment and the date the change in co-payment will become effective.
(5) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
(6) The right of the parent or caretaker to appeal the decision and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
§ 3042.159. Notice of overpayment.
(a) The eligibility agency shall notify the parent or caretaker in writing of an overpayment.
(b) The notice of overpayment must include the following:
(1) The reason for the overpayment as specified in § 3042.171 (relating to overpayment).
(2) The period of the overpayment.
(3) The amount of the overpayment.
(4) An explanation of how the overpayment was calculated.
(5) The repayment methods as specified in § 3042.176 (relating to collection), except in cases of suspected fraud.
(6) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
(7) The right of the parent or caretaker to appeal the decision on the overpayment and how to appeal as specified in §§ 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).
APPEAL AND HEARING PROCEDURES § 3042.161. Appealable actions.
A parent or caretaker has the right to appeal a Departmental or eligibility agency action or failure to act, including the following:
(1) Denial of subsidy, including a period of presumptive eligibility as specified in §§ 3042.142(c) and 3042.143(a) (relating to homelessness; and leave periods at redetermination).
(2) Termination of subsidy.
(3) Computation of the co-payment.
(4) Denial of a request for waiver of a requirement of this chapter based on domestic violence or homelessness as specified in § 3042.141 (relating to domestic and other violence) and § 3042.142.
(5) Failure of the eligibility agency to act upon a request for subsidy within the time limits specified in this chapter.
(6) Subsidy suspension as specified in §§ 3042.18 and 3042.20 (relating to absence; and subsidy suspension).
(7) Subsidy disruption as specified in § 3042.21 (relating to subsidy disruption).
§ 3042.162. Discontinuation of subsidy during the appeal process.
(a) Subsidy is not continued pending a hearing decision if the parent or caretaker appeals the disruption of subsidy when the eligibility agency lacks funding to continue subsidy to a child as specified in § 3042.21 (relating to subsidy disruption).
(b) Subsidy is suspended pending a hearing decision if the parent or caretaker fails to make timely payment of the co-payment.
§ 3042.163. Subsidy continuation during the appeal process.
(a) Subsidy continues at the prior level until the Department hears the appeal and makes a final decision, if the parent or caretaker does the following:
(1) Files an appeal that is postmarked or received no later than 10 calendar days after the date of the written notice.
(2) Appeals for a reason other than disruption of subsidy or a lack of funding.
(b) If subsidy continues as specified in subsection (a), the parent or caretaker shall continue to make timely payment of the co-payment that was in effect prior to issuance of the written notice until the Department makes a final decision as specified in § 3042.91 (relating to general co-payment requirements).
(c) If subsidy continues during the appeal process and the hearing officer finds in favor of the eligibility agency or the Department, the parent or caretaker shall reimburse the Department for the amount of the subsidy or increase in subsidy paid for child care from the proposed effective date of the written notice until the date subsidy is terminated or decreased, based on the final administrative action order.
§ 3042.164. Parent or caretaker rights and responsibilities regarding appeal.
(a) A parent or caretaker appealing a written notice shall submit a written request to the eligibility agency in accordance with Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings) within 30 calendar days following notification. The parent or caretaker shall specify the reason for the appeal and the current address and a telephone number, if possible, where the parent or caretaker can be reached during the day.
(b) A parent or caretaker may orally appeal. The eligibility agency shall document the date of the oral appeal in the case file. The parent or caretaker shall confirm the oral appeal in writing to the eligibility agency no later than 7 calendar days following the date the parent or caretaker orally requested an appeal.
(c) A parent or caretaker may authorize an adult to represent the parent or caretaker at the hearing.
(d) If the parent or caretaker wants subsidy to continue pending a hearing decision, subject to § 3042.163 (relating to subsidy continuation during the appeal process), the parent or caretaker shall submit a written appeal no later than 10 calendar days following the date the written notice is postmarked or hand-delivered to the parent or caretaker by the eligibility agency.
(e) If the parent or caretaker requests that subsidy continue pending a hearing decision, the parent or caretaker shall make timely payment of the co-payment that was in effect prior to issuance of the written notice until the Department makes a final decision as specified in § 3042.91 (relating to general co-payment requirements).
§ 3042.165. Eligibility agency responsibilities regarding appeal.
(a) If the parent or caretaker is unable to prepare a written appeal, the eligibility agency shall assist the parent or caretaker in preparing a written appeal. The parent or caretaker shall sign the appeal request.
(b) When the eligibility agency receives an appeal that is timely postmarked or delivered, the eligibility agency shall date-stamp the appeal, the envelope and the attachments with the date of receipt and retain copies of all original appeal information.
(c) The eligibility agency shall keep a copy and forward the original appeal along with the postmarked envelope to the Department's Bureau of Hearings and Appeals no later than 3 working days following the date the appeal is received by the eligibility agency.
(d) The eligibility agency may not take the proposed adverse action until 10 calendar days following the date the written notice is postmarked or hand-delivered to the parent or caretaker and then only if the parent or caretaker has not filed an appeal. Subsidy may be continued at the prior level only if the parent or caretaker meets the requirements in § 3042.163 (relating to subsidy continuation during the appeal process).
(e) The eligibility agency may take the proposed adverse action before 10 calendar days following the date a provider closes for financial difficulties or loss of certification or if funding is not available to continue subsidized care to the child.
§ 3042.166. Hearing procedures.
(a) Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings) applies to hearings that are held under this chapter, except as specifically superseded by this chapter.
(b) The Department will dismiss an appeal postmarked or received after 30 calendar days from the date the written notice is postmarked or hand-delivered to the parent or caretaker unless one of the provisions allowing for appeals after 30 calendar days applies as specified in § 275.3(b)(2) and (3) (relating to requirements).
(c) The hearing may be conducted by a telephone conference call with the parties to the appeal, including the parent or caretaker, the authorized representative of the parent or caretaker, the eligibility agency, the Department and the hearing officer.
(d) The parent or caretaker has the right to request a face-to-face hearing instead of a telephone hearing. Face-to-face hearings will be held in locations specified by the Department.
(e) If a parent or caretaker does not withdraw an appeal, the eligibility agency, or the Department, if appropriate, will take part in the scheduled hearing to justify the action to which the parent or caretaker objects.
(f) If the eligibility agency or the Department fails to appear at the hearing and the parent or caretaker appears, the parent's or caretaker's appeal will be sustained.
(g) If the parent or caretaker fails to appear for the hearing, regardless of whether the eligibility agency or the Department appears, the appeal is considered abandoned and the decision of the eligibility agency or the Department will be sustained.
(h) The Department will notify the eligibility agency and the parent or caretaker, in writing, when disposition of the appeal is made.
(i) The eligibility agency shall implement the final administrative action within the time limit ordered by the Department or on the first day child care is needed in the week following receipt of the final administrative action order.
OVERPAYMENT AND DISQUALIFICATION § 3042.171. Overpayment.
The parent or caretaker may not be required to repay an overpayment except for an overpayment resulting from one of the following:
(1) Fraud.
(2) Failure to comply with this chapter.
(3) Subsidy continuation pending an appeal when the parent or caretaker did not win the appeal.
§ 3042.172. Eligibility agency responsibilities regarding overpayment.
(a) The eligibility agency shall inform a parent or caretaker who files an appeal and requests subsidy continuation pending appeal that, if the hearing decision is in favor of the eligibility agency or the Department, the parent or caretaker shall reimburse the amount of the overpayment unless the hearing officer determines a hardship.
(b) The eligibility agency shall pursue possible overpayments in active and closed cases, including those that were voluntarily closed.
(c) The following are the responsibilities of the eligibility agency when exploring possible overpayments:
(1) Determination of whether the overpayment is the result of one of the conditions specified in § 3042.171 (relating to overpayment).
(2) Written assurance that the methods of exploring overpayments are appropriate to the particular situation and to the different eligibility factors.
(3) Assurance that the methods of exploring overpayments do not infringe on the civil liberties of individuals or interfere with the due process of law.
(4) Investigation of a credible complaint that a parent or caretaker is erroneously receiving subsidized child care.
(5) Identification and documentation of the causes of the overpayment.
(6) Computation of the amount of the overpayment.
(7) Referral of suspected fraud cases to the Office of Inspector General.
(8) Submission of an overpayment notice to the parent or caretaker as specified in § 3042.159 (relating to notice of overpayment).
(d) The eligibility agency shall refer all cases of suspected provider fraud to the Office of Inspector General.
§ 3042.173. Delaying recoupment.
(a) Recoupment shall be delayed until after a hearing decision, if the family files an appeal of the overpayment decision no later than 10 calendar days after the date the written notice is postmarked or hand-delivered to the parent or caretaker by the eligibility agency.
(b) Recoupment shall be delayed for cases referred to the Office of Inspector General for suspected fraud until the investigation is complete.
(c) The method of recoupment in cases of suspected fraud will be determined in conjunction with the Office of Inspector General.
§ 3042.174. Notifying the Department.
The eligibility agency shall notify the Department when recoupment stops before the overpayment is fully recouped.
§ 3042.175. Repayment.
The parent or caretaker shall repay the eligibility agency or Department the full amount of the overpayment.
§ 3042.176. Collection.
(a) The eligibility agency shall collect the total amount of the overpayment from a family whose child continues to receive subsidized child care when the eligibility agency identifies an overpayment as specified in § 3042.172 (relating to eligibility agency responsibilities regarding overpayment).
(b) If the Department, eligibility agency or other entity identifies an overpayment unrelated to fraud, subject to repayment as specified in § 3042.171 (relating to overpayment), related to a family whose child continues to receive subsidized child care, the eligibility agency shall:
(1) Notify the parent or caretaker by a letter that a repayment is required, the amount of the repayment and the following repayment options:
(i) A one-time payment of the full amount owed.
(ii) A one-time partial payment and an increase in the co-payment to be paid until repayment is complete.
(iii) An increase in the co-payment until the repayment is complete.
(2) Automatically implement an increase to the co-payment until the repayment is complete when the parent or caretaker does not select an option as specified in paragraph (1) no later than 10 calendar days following the date of the letter.
(3) Notify the parent or caretaker by a second letter of failure to choose a repayment option as specified in paragraph (1), the amount of the increased co-payment and the number of weeks the increased co-payment will continue.
(c) When the Office of Inspector General has determined fraud in an active case, the eligibility agency shall determine collection methods in conjunction with the Office of Inspector General.
§ 3042.177. Co-payment increase related to overpayment.
(a) A co-payment increase for the purpose of collecting an overpayment may not exceed an amount greater than 5% of the family's gross monthly income. If the parent or caretaker indicates to the eligibility agency that an increase to 5% would cause hardship to the family, the family and the eligibility agency may agree to a lesser amount.
(b) A parent or caretaker may choose to increase the co-payment beyond the amount specified in subsection (a) to repay an overpayment in a shorter period of time.
(c) The eligibility agency shall issue a written notice before implementation of an increase in the co-payment.
§ 3042.178. Collection for a family whose child is no longer in care.
(a) The eligibility agency shall collect the total amount of the overpayment as specified in § 3042.172 (relating to eligibility agency responsibilities regarding overpayment) from a family whose child is no longer receiving subsidized child care if the eligibility agency identifies an overpayment.
(b) If the Department, eligibility agency or other entity identifies an overpayment unrelated to fraud, for a family whose child is no longer receiving subsidized child care, the eligibility agency shall:
(1) Notify the Department of the subsidy termination date, the amount of the overpayment recouped and the amount outstanding. The Department will notify the parent or caretaker by letter of the overpayment, the amount of the outstanding overpayment and that repayment is required in either a single payment or under a payment plan agreeable to the parent or caretaker and the eligibility agency. The letter must state that the parent or caretaker has 10 calendar days to respond to the Department indicating agreement or disagreement and indicating the choice of a repayment method.
(2) Send a second letter that repeats the information contained in the letter specified in paragraph (1) when the Department notifies the eligibility agency that the parent or caretaker failed to respond. The second letter must also request a response from the parent or caretaker no later than 10 calendar days following the date of the letter.
(c) When the Office of Inspector General has determined fraud in a case when the child is no longer in care, the eligibility agency shall determine the collection methods in conjunction with the Office of Inspector General.
(d) The Department may institute civil legal proceedings when the parent or caretaker fails to respond to the second letter.
§ 3042.179. Disqualification.
(a) The parent or caretaker is disqualified from participating in the subsidized child care program if one of the following applies:
(1) A Federal or State court finds the parent or caretaker guilty of fraud in applying for or receiving subsidized child care.
(2) A hearing officer determines that the parent or caretaker committed fraud pursuant to the procedures and standards in Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings).
(3) The parent or caretaker signs a disqualification consent agreement as part of a court's deferred adjudication process.
(4) The parent or caretaker agrees to be disqualified by signing an administrative disqualification hearing waiver.
(b) Upon disqualification under subsection (a), a parent or caretaker and eligible children in the parent's or caretaker's family is prohibited from participation in the subsidized child care program:
(1) For 6 months from the date of the first conviction, hearing decision or determination.
(2) For 12 months from the second conviction, hearing decision or determination.
(3) Permanently from the date of the third conviction, hearing decision or determination.
(c) A parent or caretaker may not be granted a hearing on a court conviction or administrative disqualification hearing decision that led to the disqualification.
APPENDIX A
INCOME TO BE INCLUDED, DEDUCTED AND EXCLUDED IN DETERMINING GROSS MONTHLY INCOME
PART I. INCOME INCLUSIONS. Income from the following sources is included when determining total gross monthly income:
A. Money, wages or salary earned by a parent or caretaker before deductions for taxes, Social Security, savings bonds, pensions, union dues, health insurance and similar purposes, for work performed as an employee. This includes commissions, tips, piece-rate payments and cash bonuses. Income earned by an unemancipated minor is not included.
B. Armed forces pay, which includes base pay plus cash, but does not include housing subsistence, allowances or the value of rent-free quarters.
C. Voluntary and court-ordered support received for any person in the family.
D. Net income from nonresident and real property, defined as gross receipts minus the expenses for continuing the income, such as depreciation charges, business taxes (not personal income taxes), interest on mortgages, repairs and similar expenses.
E. Social Security benefits, Supplemental Security Income, survivors' benefits and permanent disability insurance payments made by the Social Security Administration before deductions of health insurance premiums.
F. Railroad retirement, disability or survivors' benefit payments made by the United States Government under the Railroad Retirement Act of 1974 (45 U.S.C.A. §§ 231—231v) before deductions of health insurance premiums.
G. State blind pension payments made by the Department.
H. Public assistance benefits or retirement benefits.
I. Private pensions and annuities, including retirement benefits paid to a retired person or their survivors by a former employer or a union, either directly or through an insurance company.
J. Government employee pensions paid by Federal, State, county or other governmental agencies to former employees, including members of the armed forces, or their survivors.
K. Unemployment compensation received from government unemployment insurance agencies or private companies during periods of unemployment and strike benefits received from union funds.
L. Workers' compensation received from private or public insurance companies.
M. Veterans' payments, defined as money paid periodically by the Veterans Administration (VA) to disabled members of the armed forces or to the survivors or dependents of deceased or disabled veterans, subsistence allowances paid to the survivors of deceased veterans and subsistence allowances paid to veterans for education and on-the-job training, as well as so-called ''refunds'' paid to ex-service persons as GI insurance premiums. For a disabled veteran in the Vocational Rehabilitation Program, the subsistence allowance and the veteran's disability allowance are counted as income.
N. Capital gains, profit from S-corporations and dividends, including dividends from stocks, bonds, mutual funds or from membership in an association.
O. Interest on savings and bonds.
P. Income from estates and trust funds.
Q. Net income from royalties.
R. Lump sum cash of more than $100; inheritances, life insurance benefits; personal injury and other damage awards and settlements; retroactive benefits such as retirement, survivor's or disability insurance and delayed unemployment: divorce settlements; gifts; or workers' compensation.
S. Lump-sum cash lottery winnings or cash prizes of more than $100.
T. Profit from self-employment, calculated as total gross receipts minus costs of doing business. The costs of doing business shall only include:
(1) Costs of maintaining a place of business, such as rent, utilities, insurance on the business and its property, and property taxes. If a business is operated in a home, the costs of maintaining a place of business are only those costs identified for the part of the home used exclusively for the business.
(2) Interest on the purchase of income-producing equipment and property.
(3) Employee labor costs, such as wage, salaries, taxes, benefits, unemployment compensation or workers' compensation.
(4) Cost of goods sold, supplies and materials.
(5) Advertising costs.
(6) Accounting and legal fees.
(7) Transportation costs necessary to produce income.
U. Net income from room rent or room and board, calculated as follows: Gross income received minus $10 per month for each room rented. Divide the remainder by 2. That number is the income inclusion.
CONVERSION TABLE Convert weekly, biweekly, semi-monthly and other pay periods to gross monthly amounts using the following Conversion Table:
Frequency of income Conversion method Daily Multiply the daily income by the number of workdays in a week, then multiply by 4.3. Weekly Multiply by 4.3. Biweekly (every 2 weeks) Divide by 2, then multiply by 4.3. Semimonthly (twice per month) Multiply by 2 for monthly gross income. Monthly Use the figure given. Quarterly Divide by 3. Annually Divide by 12. Lump sum income Divide by 12.
PART II. INCOME DEDUCTIONS. The following are deducted when determining adjusted monthly income:
A. Voluntary or court-ordered support paid by the parent or caretaker or a family member to a present or former spouse not residing in the same household.
B. Voluntary or court-ordered child support paid by the parent or caretaker or family member to a person not residing in the same household.
C. A medical expense not reimbursed through medical insurance that exceeds 10% of the family gross monthly income. The medical expense must have been incurred within the 90-day period prior to the date the parent or caretaker notifies the eligibility agency of that expense and there must be an expectation that the expense will continue to be incurred for the 6 months following the outset of the expense. Medical expenses are based on the monthly expenses or monthly payment plan, or both. Medical expenses include bills for doctors, hospital costs, dental services, health care premiums, institutional care, medications, prosthetic devices, durable medical equipment or mental health services.
D. The stepparent deduction as shown in the Stepparent Deduction Chart in Appendix C.
PART III. INCOME EXCLUSIONS. Income from the following sources is excluded in determining gross monthly income:
A. Employment earnings of an individual who is an unemancipated minor.
B. Tax refunds, including earned income tax credits.
C. Withdrawals of bank, credit union or brokerage deposits.
D. Money borrowed.
E. Nonrecurring money in amounts under $100 per person per year, given as a gift, from any source.
F. The value of benefits under the Food Stamp Act of 1977 (7 U.S.C.A. §§ 2011—2036c).
G. The value of foods donated from the United States Department of Agriculture.
H. The value of supplemental foods assistance under the Child Nutrition Act of 1966 (42 U.S.C.A. §§ 1771—1793) and the special food service programs for children under that act.
I. Loans and grants, such as scholarships, obtained and used for conditions that preclude their use for living costs.
J. Any grant or loan to an undergraduate student for educational purposes, made or insured under any program administered under the Higher Education Act of 1965 (20 U.S.C.A. §§ 1001—1161aa-1).
K. Any payment received under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (42 U.S.C.A. §§ 4601—4655).
L. Any home produce used for household consumption.
M. Any payment made on behalf of an individual for household expenses, such as rent, food and utilities.
N. Payments to Volunteers in Service to America under the Domestic Volunteer Service Act of 1973 (42 U.S.C.A. §§ 4951—5085), which include AmeriCorps income.
O. Earnings received by any youth under the Workforce Investment Act of 1998, as amended (Pub.L. No. 105-220) or the YouthBuild Program (Pub.L. No. 113-128) (29 U.S.C.A. § 3226).
P. Any foster care payments by a foster care placement agency, including payments to permanent legal custodians.
Q. Stipends derived from the Foster Grandparent Programs under section 211 of the Domestic Violence Service Act of 1973 (42 U.S.C.A. § 5011).
R. Low Income Home Energy Assistance Program (LIHEAP) benefits and cash in-kind energy assistance provided by private agencies and utility companies.
S. Any adoption assistance payments by a county children and youth agency.
T. Income received from Federal student aid or participation in a Federal work-study program.
U. Payments made by the Veterans Administration to children of Vietnam veterans under The Benefits for Children of Vietnam Veterans Act (38 U.S.C.A. §§ 1802—1834).
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