(System) Prints Form 2199 in duplicate at the screening interview for a P3 applicant.
(FCRC) When Form 2199 is not automatically printed, request Form 2199 through the Forms Option (Option F) during the eligibility interview.
A data exchange tape of P3 TA cases with new SSI applications is sent to SSA monthly. SSA uses the tape as proof that Form 2199 was signed on the P3 application date. The data exchange ensures that the client's first SSI check is sent to DHS. For the
process to be effective, require the client sign both copies of Form 2199. Give one copy to the client and file the 2nd copy in the case record, available for SSA review.
By signing Form 2199, the client authorizes their first SSI retrospective payment be sent directly to DHS. The Bureau of Fiscal Operations recovers the amount of cash assistance due DHS and sends the remaining amount to the client. If the first SSI
payment is sent to the client instead of DHS, the client is to reimburse DHS.
- (BFO) Sends with the money due the client Advice of Notification for Receipt and Disposition of State Interim Assistance (Form 1202). Form 1202 advises the client of the total amount of the SSI retroactive payment and the
amount withheld by DHS. Form 1202 also tells the client of their right to request a fair hearing regarding the distribution. If there is no money remaining after BFO recovers the amount due DHS, just Form 1202 will be sent to the client.
- (BFO) Sends a copy of Form 1202 to the FCRC.
- (FCRC) If the client requests a fair hearing, contact BFO to request confirmation of the manner the SSI payment was distributed.
- (BFO) Reviews their original determination and notifies FCRC of the outcome of their review.