7210  Completion of Form 4116

After the applicant or responsible party has been assigned a Texas Identification Number (TIN), complete Form 4116, State of Texas Purchase Voucher.

The following fields require an entry on Form 4116:

• 4 – Enter the TIN.
• 6 – Enter the total document amount (the total amount requested on Form 4116).
• 7 – Enter the payee name/address.
• 9 – SFX 001, Enter in fields:
• AY – Enter the two-digit year to which the expenditure should be charged. (See Form 4116 Instructions for details.)
• Account – Enter the appropriate account number according to the type of grant. For Subsidy, enter 767315.
• Amount – Enter the amount allotted for the designated account number.
• Invoice No. – Enter the word Subsidy with the above account number.
• MM/YY of Service – Enter the month and year Form 2065-E, Notification of In-Home and Family Support Program Benefits, is completed to authorize funds for this transaction. The month and year will be the same as the entry in Field 10.
• Dept ID – Enter the three-digit region number.
• Program – Enter 645.
• Speed Chart – Enter the speed chart code.
• 10 – Enter the MM/DD/YY that Form 2065-E is completed to authorize funds for this transaction. This month and year must match Field 9, MM/YY of Service.
• 11 – Enter "Payment in accordance with Human Resource Code §35.001 – §35.012." Enter the total requested for Subsidy and zero for Capital.

Example: Payment in accordance with Human Resource Code §35.001 – §35.012.

Capital $0
Subsidy $800

Note: Both Capital and Subsidy must be listed here. Fiscal is requiring that a total appear for each one, even if the amount is zero.

• 14 – Enter the total Subsidy. This field must match Field 6.
• 15 – Enter the DADS case manager name and telephone number.
• 17 – The case manager must sign the first line and print his name next to it. He must also enter his Mail Code, telephone number and date. The supervisor will do the same on the second line.

DADS Accounts Payable Speedchart

The case manager must sign Form 4116 and print his name next to his signature. The case manager must submit Form 4116, along with any appropriate case documentation, to the unit supervisor upon completion of the certification or recertification. Telephone numbers and mail codes of the case manager and supervisor must be included on the form.

The supervisor must review Form 4116 and forward it to Fiscal Management Services within seven calendar days of the case manager's signature on the form. Obtaining the supervisor's signature on Form 4116 is not included in the 45-day time frame for application completion.

The supervisor is not required to review every case prior to reviewing and signing Form 4116. Staff should contact regional management to determine if, and under what circumstances, review of the case is required.

7211  Electronic Submission to DADS Accounts Payable Unit

Once the following forms are completed (including supervisory approval, if appropriate), they are sent electronically to the Department of Aging and Disability Services (DADS) Accounts Payable Unit:

• Form 4116, State of Texas Purchase Voucher
• Form 4109, Application for Texas Identification Number
• Form 4110, Payee Change Request

Use the following instructions when submitting forms electronically:

• Scan the completed form at the multi-function office Workcenter.
• Save the document using the default document name created in the scanning process.
• Retrieve the scanned document and attach to an email. The subject line of the email must include the region number, program name and form name, in that order. For example, an email submission of Form 4116 from Austin would read: "Region 07 IHFSP Form 4116." If Form 4116 is being sent at the same time as Form 4109 or 4110, both documents must be attached in the same email.
• Send the document via encrypted email to IHFSForms@dads.state.tx.us. This email address can be found in Outlook under the name "DADS IHFS Subsidy Forms." This address must be used for submitting Form 4116 requesting a subsidy grant.
• File the document signed by the unit supervisor, original or copy, in the case record.

7212  Completing a Change of Address or Other Information

If changes are needed to update an individual's address or to correct other information in the Health and Human Services Administrative System (HHSAS) Financials or the Comptroller's Texas Identification Number (TIN) System, the case manager must complete Form 4110, Payee Change Request. There are two options for completing this procedure:

Option One – Complete the change request before submitting Form 4116, State of Texas Purchase Voucher.

1. Submit Form 4110 as an attachment in an email sent to the Outlook TIN Requests public folder at tinrequests@dads.state.tx.us.
2. When Form 4110 has been processed, a notification will be sent to the case manager, identifying the change that has been made. This notification should be kept as a reference.
3. Once the case manager receives notification that Form 4110 has been processed, the case manager will send Form 4116.

Option Two – Complete the change request in conjunction with submission of Form 4116.

1. Submit Form 4110 with the corresponding Form 4116.
2. When Form 4110 has been processed, a notification will be sent to the case manager identifying the change that has been made. This notification should be kept as a reference.

7310  Replacement of Lost Program Funds

If an individual loses In-Home and Family Support Program (IHFSP) funds after the check has been cashed, funds cannot be replaced. If funds have not been repaid to the Department of Aging and Disability Services (DADS) or if allowable receipts have not been submitted to the case manager, the individual must be placed on spend down or repayment in accordance with Section 8300, When Receipts are Not Provided.

If the individual is robbed after the check is cashed and funds are stolen, IHFSP eligibility is retained without submission of receipts or repayment for the missing amounts. The individual or responsible party must provide the case manager with a police report verifying the theft at the next six-month review or recertification.

Benefits may be replaced when it is established that a check has been stolen or forged. Upon being informed by the individual that a check has been stolen, the case manager must contact DADS Accounts Payable to attempt to cancel the check. If the check has already been cashed but the individual claims the signature was forged, the case manager must request a photocopy of the check to examine the signature. If it appears to be forged, a new warrant may be issued. If it does not appear to be forged, the case manager must treat the case as he would if the funds had been lost after cashing the check.

To secure replacement funds for the individual, the case manager must submit a copy of Form 4116 marked "DUPLICATE" to the appropriate section of DADS Accounts Payable. The case manager must attach a memo explaining the reason for the duplicate voucher. The case manager must also attach a completed Form 1084, Certification for Warrants Lost, Destroyed, Stolen or Not Received.

7320  Withheld Warrants

The Office of the Comptroller withholds In-Home and Family Support Program (IHFSP) warrants from individuals who have an outstanding debt to a state agency or institution of higher education, in accordance with Texas Government Code §403.055. Common debts are delinquent student loans, delinquent state taxes, outstanding child support payments or overpayment of unemployment benefits.

The Comptroller sends a Notice of State Warrant(s) Held letter to the individual when the IHFSP warrant is issued and held. The notice includes payment information, liability owed, the holding agency or institution contact information and a statement that the warrant may be offset 30 days following the issue date of the notice. "Offset" is defined as using all or a portion of the amount of a warrant to satisfy a liability owed. If a resolution between the individual and the hold agency is not reached within 30 days, the Comptroller's office initiates an offset of the warrant. The Comptroller issues another warrant if there is any money remaining after the original warrant was applied to the outstanding debt.

To determine how to handle withheld warrants, see:

• Section 7321, Warrants Held for Delinquent Student Loans;
• Section 7322, Warrants Held for Delinquent State Taxes;
• Section 7323, Warrants Held for Delinquent Child Support Payments; or
• Section 7324, Warrants Held for Overpayment of Unemployment Benefits.

7321  Warrants Held for Delinquent Student Loans

When an individual's warrant is held by the Comptroller's office, the Accounting division sends an email to the In-Home and Family Support Program (IHFSP) case manager's supervisor containing the individual's name, Texas Identification Number (TIN), warrant number, issue date, amount, and the name and telephone number of the agency requesting the hold. This email instructs staff to notify the individual to take action to get the loan discharged so the warrant can be released.

The supervisor forwards this information to the assigned case manager immediately upon receipt. The case manager prints the notification for the case record and contacts the individual within 10 days from the date the information is received from the supervisor. Contact must be made as soon as possible to increase the individual's chances of resolving the situation and receiving IHFSP assistance. At this contact, the case manager gives the individual the contact information listed in the email and explains that he must contact the holding agency to resolve the delinquent debt before he can receive his IHFSP warrant. The case manager documents this contact in the case narrative.

When the warrant has been released and mailed to the individual, Accounting notifies the IHFSP case manager's supervisor via email. When the supervisor forwards this information, the case manager prints a copy for the case record to document the resolution.

If the individual fails to resolve the situation and a subsequent warrant is issued, the case manager's supervisor receives notification via email from Accounting as described above. The case manager follows the same procedures outlined above regarding individual contact and notification.

7322  Warrants Held for Delinquent State Taxes

When an individual's warrant is held for delinquent state taxes, Accounting contacts the Comptroller of Public Accounts and requests the release of the warrant. Although the delinquent state taxes are still due, the Comptroller has agreed to release In-Home and Family Support Program (IHFSP) warrants in order for individuals to avoid economic hardship.

In addition, Accounting sends an email to the IHFSP case manager's supervisor containing the individual's name, Texas Identification Number (TIN), warrant number, issue date, amount, and the name and telephone number of the agency requesting the hold. This email notifies staff that the warrant will be released and instructs staff to notify the individual to contact the Comptroller of Public Accounts to resolve the outstanding state tax debt to prevent delays of any future payments.

The supervisor forwards this information to the assigned case manager immediately upon receipt. The case manager prints the notification for the case record and contacts the individual within 10 days from the date the information is received from the supervisor. Contact must be made as soon as possible to increase the individual's chances of resolving the situation and preventing delays of future IHFSP assistance. At this contact, the case manager gives the individual the contact information listed in the email and explains that he must contact the holding agency to resolve the delinquent state tax debt to prevent delays of future IHFSP warrants. The case manager documents this contact in the case narrative.

When the warrant has been released and mailed to the individual, Accounting notifies the case manager's supervisor via email. When the supervisor forwards this information, the case manager prints a copy for the case record to document the resolution.

If the individual fails to resolve the situation and a subsequent warrant is issued, Accounting again contacts the Comptroller of Public Accounts and requests that the warrant be released. The case manager's supervisor receives notification via email from Accounting as described above. The case manager follows the same procedures outlined above regarding individual contact and notification.

7323  Warrants Held for Delinquent Child Support Payments

Warrants withheld for delinquent child support should not occur because the individual has signed Form 2351-A, Child Support Declaration, as part of the eligibility determination. If the case manager's supervisor receives notice from Accounting that a warrant is held for this reason, the supervisor or case manager consults with state office on the procedures to follow to resolve this situation.

7324  Warrants Held for Overpayment of Unemployment Benefits

When an individual's warrant is held by the Comptroller's office, Accounting sends an email to the In-Home Family Support Program (IHFSP) case manager's supervisor containing the individual's name, Texas Identification Number (TIN), warrant number, issue date, amount, and the name and telephone number of the agency requesting the hold. This email instructs staff to notify the individual to repay the unemployment benefits overpaid so the IHFSP warrant can be released.

The supervisor forwards this information to the assigned case manager immediately upon receipt. The case manager prints the notification for the case record and contacts the individual within 10 days from the date the information is received from the IHFSP supervisor. Contact must be made as soon as possible to increase the individual's chances of resolving the situation to receive IHFSP assistance. At this contact, the case manager gives the individual the contact information listed in the email and explains that he must resolve the overpayment of unemployment benefits before receiving the IHFSP warrant. The individual also receives a letter from the Comptroller's office or the Texas Workforce Commission (TWC) explaining that a warrant is on hold and is being used to pay his liability (or being partially used, depending on the amount owed), unless the individual contacts TWC to make payment arrangements. The individual must contact TWC to resolve the delinquent debt before receiving the IHFSP warrant. The case manager documents this contact in the case narrative.

The individual can retain program eligibility as long as he can provide acceptable receipts(s) from the Comptroller's Office or TWC, or from the purchase of allowable items identified in his service plan. However, the individual must wait until the delinquent debt is resolved before actually receiving a warrant. The receipts must meet the requirements in Section 8100, What Constitutes an Acceptable Receipt.

Once the debt has been repaid and acceptable receipts are received, the individual can once again receive benefits from IHFSP. If the individual fails to resolve the situation and a subsequent warrant is issued, the case manager's supervisor again receives notification via email from Accounting as described above. The case manager follows the same procedures outlined above regarding individual contact and notification.

In all situations, the individual is expected to resolve the situation promptly so the full amount of the warrant can be released. If the individual signs over the entire warrant to the holding agency or fails to contact the holding agency and the warrant is used to offset the debt without his approval, and he does not provide receipts from the Comptroller's office or TWC or from his own purchased allowable items, the case manager handles the situation as described in Section 8300, When Receipts are Not Provided.