MFIP, DWP, SNAP:
No provisions.


MSA:
Follow GA for non-SSI interim assistance.

If the client becomes retroactively eligible for SSI, review the case for retroactive MSA eligibility.

●	Only months that GA has been reimbursed through the DHS/SSI interim assistance reimbursement (IAR) process (or months for which the county received reimbursement directly from the client) are eligible for MSA.
●	Refer to the DHS Financial Operations MAXIS CASE/NOTE for which months have been reimbursed (see GA above).
●	Issue retroactive MSA payment(s) based on the client’s current MSA basic needs grant. Do not include special need items.
●	A GA reimbursement may remain due from the client for a specific month. This typically happens when counties are unable to close GA in time to prevent an additional GA payment after SSI begins. If this occurs, budget the full SSI benefit rate, without any disregard, plus the GA for that month against the appropriate MSA standard. The difference would be either the amount of GA the client continues to owe or the amount of MSA to be issued to the client.

NOTE:

GRH payment months are not eligible for retroactive MSA.

GA:
An Interim assistance agreement (IAA) allows the state, county, or tribal agencies to seek repayment of GA benefits issued while an application for other maintenance benefits is pending and then approved. For more information about other maintenance benefits, see 0012.12 (Applying for Other Benefits).

WHO MUST COMPLETE AN INTERIM ASSISTANCE AGREEMENT
Require clients to complete an interim assistance agreement (IAA) if their basis of eligibility is:

●	Permanent illness.
●	Temporary illness.
●	Placement in a facility.
●	Unemployable.
●	Developmental disability/mental illness.
●	RSDI/SSI application/appeal pending.
●	Advanced age.
●	Learning disabled.
●	Any time a client applies for other maintenance benefits such as Supplemental Security Income (SSI).
	OR
●	RSDI or SSI benefits are suspended or terminated, and the client requested a review or appeal of their Social Security Administration (SSA) benefits and are awaiting a decision by SSA to reverse the suspension or termination.

INTERIM ASSISTANCE AGREEMENT FORMS
Clients who meet a GA basis listed above, or are potentially eligible for Supplemental Security Income (SSI) must complete the SSI Interim Assistance Authorization (DHS-1795) (PDF).

Clients who are potentially eligible for other benefits such as RSDI, Workers’ Compensation, Veterans benefits, or private insurance (such as short or long-term disability; or auto, business or home liability insurance) must complete the Interim Assistance Agreement (Non-SSI) (DHS-1795A) (PDF).

Clients who are potentially eligible for both SSI and other benefits must sign and date both a DHS-1795 and a DHS-1795A.

IAA forms used for SSI and RSDI must comply with SSA requirements. SSA does NOT accept verbal signatures. SSA accepts digital/electronic, pen capture and “wet” signatures on the IAA’s.

For IAAs to be valid they must be:

●	Signed and dated by the:
	-applicant
	-parent, if the applicant is a child; or
	-legal guardian, if the applicant is legally incompetent;
	AND
●	Signed and dated by the agency after the client signs and dates the forms; AND
●	Entered on the IAA Date filed on STAT/PBEN within 30 days from the date the agency received the form(s). Add a MAXIS CASE/NOTE indicating that an IAA was received.

Note: An authorized representative cannot sign IAA forms unless they are the parent or legal guardian of the applicant.

IAA forms signed and dated by an applicant/participant more than 30 days before a Combined Application Form (CAF) or Change Report Form is received are invalid. Enter a case note and file the invalid IAAs. Inform the client that they have 30 days to complete and return new IAA forms. For more information on coding STAT/PBEN see TEMP Manual TE02.12.14 (Interim Assistance Reimbursement Interface

Do not approve benefits until the client returns the signed and dated form(s). If, after 30 days, the client does not sign and date the forms(s), deny benefits. Clients who refuse to sign and date the DHS-1795 or DHS 1795A are ineligible for GA

Once IAA forms are completed by the client and agency, and the STAT/PBEN panel is updated, approve benefits. Benefits may be approved before the client applies for other maintenance benefits if all other program requirements are met.

WHEN MUST AN IAA BE COMPLETED
SSI Interim Assistance Authorization (DHS-1795) and/or Interim Assistance Agreement (Non-SSI) (DHS-1795A) must be completed when the following occur:

●	Agency receives a new application for GA and the applicant meets a GA basis listed above. - IAAs are required even if the person is not referred to apply for RSDI or SSI, or is granted good cause to delay their application. - A person reapplies for GA and a new application is required. New IAAs are needed even if the ones on file are less than a year old. - If the case is reinstated new IAAs are not needed
●	Agency receives one of the following DAIL messages: - INFC: SDX MATCH/HAS SSI PENDING BUT NO IAA DATE ON PBEN - INFC: SCX MATCH/HAS SSI PENDING/MAXIS CREATED PBEN/NEED IAA DATE
●	There is a change in circumstances and the agency is now referring the person to apply for RSDI or SSI.
●	Agency receives information the participant applied for RSDI or SSI
●	The client’s SSI or RSDI is suspended or terminated and they requested a review or appeal and are awaiting a decision by SSA to reverse the suspension or termination

Note: Clients do not need to sign and date new IAA forms at recertification.

Once IAA forms are signed and dated, they remain valid until 1 of the following occur:

●	Social Security Administration (SSA) approves the SSI and/or RSDI application.
●	SSA denies an application and client does not appeal the decision within 60 days.
●	Client does not apply for other benefits, SSI and/or RSDI within 1 year of signing and dating the form(s).
●	Client and agency agree in writing to end IAA authorization(s).

INTERIM ASSISTANCE REIMBURSEMENT
Immediately close GA with a 10 day notice and determine MSA eligibility of any client SSA finds eligible for SSI or RSDI. See MSA above.

People who sign and date the DHS-1795 for SSI agree to let the Social Security Administration (SSA) reimburse the state for GA received during the period of retroactive SSI eligibility. DHS will mail a notice and explanation to clients and will notify counties via MAXIS CASE/NOTE when clients become eligible for SSI and the state has been reimbursed. Refer any remaining questions regarding SSI interim assistance reimbursements to DHS Financial Operations at 651-431-2427 or 1-888-702-9975.

For benefits that clients may receive directly, request repayment directly from the client. To request any non-automatic repayment of interim assistance from the client, send the client the Interim Assistance Repayment Request (DHS-4571). This form can be used to request repayment from non-SSI IAA or SSI IAA. If the client does not voluntarily repay the benefits issued, begin action to recover it. See 0025 (Benefit Adjustments and Recovery).

When the client’s only source of income is RSDI and the client has no other resources, the county must ask the client to voluntarily repay the interim assistance he/she received. If the client refuses to voluntarily repay the interim assistance, the county may initiate a civil action to recover the interim assistance. The DHS-1795A includes a statement informing clients that RSDI payments, both retroactive and current, cannot be garnished, attached, executed upon, or levied upon. The form also explains that, although clients cannot be forced to use their RSDI benefits to repay the interim assistance they received, they can voluntarily use their RSDI benefits to repay their state debt.

Notify the DHS Benefit Recovery Section (BRS) of clients who sign and date a DHS-1795A for Workers' Compensation. BRS will seek recovery of benefits paid during the period covered by the Workers' Compensation claim.


GRH:
Follow GA, with the following EXCEPTION:

If the client becomes retroactively eligible for SSI, review the case for retroactive GRH eligibility. Consider the following:

●	Do not recalculate the client's GRH budget for months that GRH has been reimbursed through the DHS/SSI Interim Assistance Reimbursement (IAR) process or months for which the county received reimbursement directly from the client.
●	If GRH was not reimbursed through the DHS/SSI Interim Assistance Reimbursement (IAR) process or voluntarily repaid by the client, the GRH budget must be recalculated for the months in which the client received SSI.