Overpayment Process
Administrative Fairness & Legal Authority
Overpayment Process
Training
No OP
Determined
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP
Confirmed
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
October 2008
Page 1
October 2008
Slide 1
Overpayment Process
Administrative Fairness & Legal Authority
Welcome to the Overpayment
Process Training
No OP
Determined
Consistency, transparency, and the application of
administrative fairness are key components of all
ministry decisions and communication with clients.
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP
Confirmed
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
The information contained in this training is intended for
Ministry staff to enhance their understanding of the
overpayment process.
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October 2008
Slide 2
Overpayment Process
Administrative Fairness & Legal Authority
At the end of this training you will be able to:
 describe the overpayment process,
 explain the principles of Administrative Fairness and
how they apply to the overpayment process; and
 discuss related legal authorities.
No OP
Determined
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP
Confirmed
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
Page 1
October 2008
Slide 3
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
No OP
Determined
No OP
Determined
Potential
Overpayment
Identified
Overpayment
Identified
Information
Gathering
Information
Gathering
Review
&
Review
Assessment
&
Assessment
OP Determined
OP
Confirmed
Debt
Calculation
Debt
(OPC)
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
This flowchart outlines the Overpayment Process for staff.
The overarching principles guiding the process of determining and actioning
overpayments are Administrative Fairness and our Legal Authorities.
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October 2008
Slide 4
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
Administrative Fairness
No OP
No OP
Determined
Determined
Refers to a set of legal principles that courts will apply to the exercise of public
Notification of
Review
Debt
Notification of
Information
Review
Debt
Overpayment
Information
OP
Overpayment
powers.
Overpayment
&
Calculation
Sanctions
OP
Overpayment
&
Calculation
Sanctions
Gathering
Identified
Gathering
Confirmed
Identified
Assessment
Assessment
Confirmed
(OPC)
(OPC)
Under this process clients have a right to:
 know the reasons for a decision that affects them
 know the case against them
 have an opportunity to reply
 have an unbiased decision maker
 have the person hearing the case decide the case
Ministry staff apply these principles when making a decision related to a client’s
eligibility for assistance and to all activities leading to the decision.
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October 2008
Slide 5
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
No OP
No OP
Determined
Administrative Fairness (continued)
Determined
When
makingInformation
a decision, the
Notification of
Review ministry provides the client:
Debt
Notification of
Review
Debt
Overpayment
Information
OP
Overpayment
Overpayment
&
Calculation
Sanctions
OP
Overpayment
&
Calculation
Sanctions
Gathering
Identified
Gathering
Confirmed
Identified
Confirmed
Assessment
(OPC)
Assessment
(OPC)
 the substantive reasons for making the decision
 the regulatory basis for the decision
 an opportunity to respond to the information and provide their own
evidence regarding the decision
The ministry also offers the client a copy of all available information on which the
decision was based, the right to reconsideration and appeal, and assists the
client with the reconsideration and appeal process.
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October 2008
Slide 6
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
Legal Authority
No OP
No OP
Determined
Determined
Ministry staff operate underReview
the authority of the Employment
and
Assistance (EA)
Notification of
Debt
Information
Overpayment
OP
Overpayment
Notification of
&
Calculation
Sanctions
Review
Debtwith Disabilities
Act
and the Employment
and
Assistance
for Persons
(EAPWD)
Gathering
Information
Identified
Overpayment
Confirmed
OP
Overpayment
Assessment
(OPC)
&
Calculation
Sanctions
Gathering
Identified
Confirmed
Assessment
(OPC)
Act.
The ministry is authorized to obtain and verify client information under Section 10
of these Acts.
The ministry obtains the consent of the individual prior to any collection of their
information, and before any third party check is done.
The client provides consent for the ministry to obtain information by signing the
HSD80 form (Application for Assistance) at intake and at re-application interviews.
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October 2008
Slide 7
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
Legal Authority (continued)
No OP
No OP
Determined
Determined
Under section Information
10 staff may Review
perform reviews or auditsDebtthat relate
to eligibility
of
Notification
of
Overpayment
OP
Overpayment
Notification of
&
Calculation
Sanctions
Review
Debt
Gathering
Information
Identified
Overpayment
Confirmed
OP
the
client.
Overpayment
Assessment
(OPC)
&
Calculation
Sanctions
Gathering
Identified
Assessment
Confirmed
(OPC)
The collection, use and disclosure of information under the Acts is governed by
the following:
 Freedom of Information and Protection of Privacy Act (FOIPPA)
 Provisions of any applicable Memorandum of Understanding (MOU)
or Information Sharing Agreement (ISA) entered into by the ministry
 Information and Communications Technology Resource Usage
Policy/Agreement
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October 2008
Slide 8
Overpayment
OverpaymentProcess
Process
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
Legal Authority (continued)
No OP
No OP
Determined
Determined
The
following
two slidesReview
quote the relevant
portions
of Section
10 of
Notification of
Debt
Information
Overpayment
OP
Overpayment
&
Calculation
Sanctions
Gathering
Identified
Confirmed
Assessment
(OPC)of the Employment
the
Employment
and Assistance
Act.
Section 10
and Assistance for Persons with Disabilities Act is identical, except
that the term “Income Assistance” is replaced with “Disability
Assistance”.
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP
Confirmed
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
Omitted sections [(1) (a), (c) and (d); (3); and (5)] relate to the
application process, employability skills and employment plans.
These are not relevant to the overpayment process.
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October 2008
Slide 9
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
No OP
Determined
No OP
Employment and Assistance Act - Section 10
Determined
Information and Verification
Overpayment
Identified
Overpayment
Identified
Information
Gathering
Information
Gathering
Review
&
Review
Assessment
&
Assessment
OP
Confirmed
OP
Confirmed
Debt
Calculation
Debt
(OPC)
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
(1) For the purposes of:
(b) determining or auditing eligibility for income assistance, hardship
assistance or a supplement
The minister may do one or more of the following:
(e) direct… a recipient to supply the minister with information within the
time and in the manner specified by the minister;
(f) seek verification of any information supplied to the minister by… a
recipient;
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(g) direct… a recipient to supply verification of any information he or she
supplied to the minister.
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October 2008
Slide 10
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
No OP
No OP
Determined
Determined
Employment and Assistance Act Section 10 (continued)
Overpayment
Identified
Overpayment
Information
Gathering
Information
Review
&
Review
Assessment
&
OP
Confirmed
OP
Debt
Calculation
Debt
(OPC)
Calculation
Notification of
Notification of
Overpayment
Sanctions
Overpayment
Sanctions
Gathering may direct… a recipient
(2) The minister
verification
of
Identified
Confirmedto supply
Assessment
(OPC)
information received by the minister if that information relates to the
eligibility of the family unit for income assistance, hardship assistance
or a supplement.
(4) If… a recipient fails to comply with a direction under this section, the
minister may declare the family unit ineligible for income assistance,
hardship assistance or a supplement for the prescribed period.
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October 2008
Slide 11
Overpayment Process
Process
Overpayment
Administrative Fairness & Legal Authority
Administrative Fairness & Legal Authority
No OP
No OP
Determined
Section 10 – Permitted Actions
Determined
Notification of
Debt
Under
staffReview
may:
Information
Overpayment the regulation,
OP
Notification of
Overpayment
&
Calculation
Sanctions
Review
Debt
Gathering
Information
Identified
Overpayment
Confirmed
OP
Overpayment
Assessment
(OPC)
&
Calculation
Sanctions
Gathering
Identified
Confirmed of information
 direct a client to provide
verification
they have provided
Assessment
(OPC)
or that the ministry has received from another source
 contact a third party directly to verify information provided by the client
 declare that a client who does not comply with a direction to provide
verification of information is not eligible for assistance until they comply.
The decision to declare the client ineligible for failure to comply with a direction
under Section 10 is discretionary. Currently, the ministry only applies this
sanction if the direction to provide verification of information relates to present
eligibility.
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October 2008
Slide 12
Overpayment Process
Section 10 Matrix
Administrative Fairness & Legal Authority
Section
Permitted Actions
Scope/Limits
Sanctions
The minister may:
 Direct client to provide
information
 Staff may specify how
and when information is
to be provided
 Must be information necessary for
auditing or determining eligibility for
No OP
assistance
Determined
Failure to provide information when
directed to do so may result in
ineligibility until compliance occurs (if
information relates to current eligibility).
10 (1) (e)
Direct a client to supply the
minister with information within
the time and in the manner
specified by the minister
Overpayment
10 (1) (f)
Identified
Information
Gathering
Review
 Ask third party
& directly
Assessment
Seek verification of any
information supplied to the
minister by the client
10 (1) (g)
Direct a client to supply
verification of any information
he or she supplied to the
minister
10 (2)
Direct a client to supply
verification of information
received by the minister if that
information relates to eligibility
for assistance.
 Direct client to provide
information
Debt
None
 Must be information that confirms
eligibility information previously provided
by client
Failure to provide information when
directed to do so may result in
ineligibility until compliance occurs (if
information relates to current eligibility).
 Unlike directions under 10 (1) (e), the
manner and timeframe for the
information are subject to
reconsideration by recipient
 Direct client to provide
information that
verifies/disproves
information received from
a third party
Notification of
Overpayment
 Must beOPinformation that relates
directly
Calculation
Confirmed
(OPC)
to eligibility
of client and in relation
to
information previously provided by client
 Must be information that relates to
eligibility
 The request must be in relation to
verifying information client previously
provided or from a third party and there
must be a clear connection between the
client file information and the third party
Sanctions
Failure to provide information when
directed to do so may result in
ineligibility until compliance occurs (if
information relates to current eligibility).
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October 2008
Slide 13
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Information
Gathering
Review
&
Assessment
OP No
Determined
OP
Review
&
Assessment
OP
Confirmed
Determined
Potential Overpayment Identified
Overpayment
Identified
Debt
Calculation
(OPC)
Debt
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
Staff may identify that a client has potentially received an overpayment through
conducting file reviews, responding to fraud allegations, and/or reviewing various
data matches.
Overpayments may occur as a result of client error (intentional or unintentional) or
ministry error.
Potential overpayments involving a duration of three months or longer must be
referred to PLMS.
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October 2008
Slide 14
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP No
Determined
OP
Determined
Debt
Calculation
(OPC)
Information Gathering / Data Collection
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP
Confirmed
Debt
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
Staff gather information and collect data by:
 Reviewing and verifying information previously provided by the client
 Contacting clients to request additional information and to inform the
client why the information is being requested
 Conducting Third Party Checks and data matches
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October 2008
Slide 15
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Review
&
Assessment
Review and Assessment
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP No
Determined
OP
Determined
OP
Confirmed
Debt
Calculation
(OPC)
Debt
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
Staff conduct a review and assessment of a potential overpayment by:
 Analyzing the information provided by the client compared to other
information collected by the ministry, identifying discrepancies or
inconsistencies
 Contacting the client and giving him/her the opportunity to respond to
discrepancies or inconsistencies, to discuss the situation, and to provide
clarification. The client may provide additional information (for instance, utility
bills to demonstrate shelter costs) that will clarify his or her eligibility.
 Determining if an overpayment has occurred, the nature of the overpayment
and the appropriate course of action
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October 2008
Slide 16
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP No
Determined
OP
Determined
No Overpayment Determined
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP
Confirmed
Debt
Calculation
(OPC)
Debt
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
Staff complete the following when no overpayment has been
determined:
 Compile and file the information collected
 Document that there was no overpayment identified
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October 2008
Slide 17
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Review
&
Assessment
Overpayment Determined
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP No
Determined
OP
Determined
OP
Confirmed
Debt
Calculation
(OPC)
Debt
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
If a client received assistance for which he or she was not eligible, an
overpayment has occurred.
If an overpayment is determined, staff explain the overpayment to the
client, how it occurred, and ensure the client understands his or her
responsibilities and rights (including reconsideration & appeal).
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October 2008
Slide 18
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Debt Calculation
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP No
Determined
OP
Review
&
Assessment
OP
Confirmed
Determined
Debt
Calculation
(OPC)
Debt
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
Overpayments are calculated by comparing the assistance a client received to
the amount for which the client was eligible. Under the EA Act section 27 and
the EAPWD Act section 18, clients are liable to repay amounts they received
for which they were not eligible.
Ministry staff use the Overpayment Calculator (OPC) online systems tool to
calculate debt and to ensure accuracy of calculations and consistent
application of the regulations. The calculation must be recorded and
substantiated with supporting documentation.
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The client is notified in writing of the overpayment.
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October 2008
Slide 19
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OPNo
Determined
OP
Determined
Notification of Overpayment
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP
Confirmed
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
Ministry staff complete the following when notifying a client of an overpayment:
 Send a Notification of Overpayment letter (HSD3092)
 Contact the client to:
• Discuss the overpayment & provide the opportunity to respond
• Explain the overpayment calculation, the rationale (the substantive reasons for
the decision), and the supporting documentation (for example, the OPC chart).
• Explain the overpayment is a debt to the government, and the recovery process
• Offer the client the right to reconsider, explain the process, and provide a
Reconsideration and Appeals brochure.
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 Record the details on the client’s file
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October 2008
Slide 20
OverpaymentProcess
Guidelines
Overpayment
No OP
Administrative Fairness
Determined& Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Review
&
Assessment
Sanctions (Discretionary)
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP No
Determined
OP
Determined
OP
Confirmed
Debt
Calculation
(OPC)
Notification of
Overpayment
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
Sanctions
The EA Act Section 15.1 and the EAPWD Act Section 14.1 set out sanctions
that may be applied if an overpayment results from inaccurate or incomplete
reporting by the client. If an overpayment has been confirmed, staff must
determine if a sanction for inaccurate or incomplete reporting is to be
applied. The decision to apply this sanction is discretionary.
The sanction, if applied, is a reduction of $25 in assistance for:
 Three calendar months for the first occurrence,
 Six calendar months for the second occurrence, and
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 Twelve calendar months for the third or subsequent occurrences.
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October 2008
Slide 21
OverpaymentProcess
Guidelines
Overpayment
No OP
Determined
Administrative Fairness & Legal Authority
Potential
Overpayment
Identified
Information
Gathering
Review
&
Assessment
OP Determined
No OP
Determined
Debt
Calculation
(OPC)
Notification of
Overpayment
Sanctions
Sanctions (continued)
Review
Debt
Notification of
Information
OP
& apply a sanction
Calculation
When assessing
for inaccurate
orOverpayment
incomplete Sanctions
Gathering whether to
Confirmed
Assessment
(OPC)
reporting, staff are to use discretion, based on the circumstances. Staff should
consider:
 Are there legitimate mitigating circumstances that resulted in the client
not having accurate or complete information on the reporting date - for
instance, delayed bank statements?
 Does the client’s mental health prevent accurate and complete
reporting?
 Does imposing the sanction serve the intended purpose of
encouraging accurate reporting in the future; for example, did the
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situation occur in the past and has the client, since then, provided
accurate and complete reports?
Overpayment
Identified
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October 2008
Slide 22
Overpayment
Guidelines
Overpayment
Process
No OP
Administrative Fairness
& Legal Authority
Determined
Potential
Overpayment
Identified
Overpayment
Identified
Information
Gathering
Information
Gathering
Review
&
Assessment
Review
&
Assessment
No OP
OP Determined
Determined
OP
Confirmed
Debt
Calculation
(OPC)
Debt
Calculation
(OPC)
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
Sanctions (continued)
If a sanction for inaccurate or incomplete reporting is applied, staff must
contact the client and provide him/her an opportunity to respond, advise the
client that he/she may request a reconsideration of the decision, provide a
Reconsideration and Appeals brochure, and assist the client with the
reconsideration process.
Page 1 Page 1
October 2008
Slide 23
Overpayment
Overpayment Guidelines
Process
Administrative Fairness & Legal Authority
No OP
Determined
No OP
Determined
Potential
Overpayment
Overpayment
Identified
Identified
Information
Gathering
Information
Gathering
Review
&
Review
Assessment
&
Assessment
OP Determined
OP
Confirmed
Debt
Calculation
Debt
(OPC)
Calculation
Notification of
Overpayment
Notification of
Overpayment
Sanctions
Sanctions
(OPC)
This concludes the Overpayment Process training
Please contact your local IO for further support
Thank you
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October 2008
Slide 24