- To serve as the consolidated record of the total number of recipient or individual provider suspected fraud cases referred to the supervisor during the month by the workers within the local unit.
- To serve as the means by which the supervisor identifies and records the progress and disposition of each recipient or individual provider case referred to the investigative unit for investigation of suspected fraud.
- To serve as the consolidated record of the total fraud referrals submitted to the investigative unit or during the month by each local supervisory unit.
- To serve as the local supervisory unit's monthly report of fraud referrals which is submitted to the appropriate program director for purposes of review and management.
When to Prepare
Form H4831 is an ongoing record which is maintained by the local financial services, food stamp, or social services unit supervisor for a month at a time. As each Form H4830, Recipient or Individual Provider Fraud Referral, is received by the supervisor from a worker within the unit during the reporting period, it is logged on Form H4831. It is quite possible that in some areas this monthly report may require more than one page.
The progress or disposition of each fraud referral which was referred to the investigative unit is noted on Form H4831 as reported by the investigative unit by Forms H4834 and H4836. All Forms H4834 and H4836 prepared by the investigative units are routinely mailed to the appropriate local unit supervisors for posting of information.
The supervisor will immediately enter the information on Form H4831.
Investigations into suspected fraud often extend over several weeks or months. Therefore, when a Form H4831 is started at the beginning of the new month, all referrals for which notice of the final disposition has not yet been received from the investigative unit are carried over from the Form H4831 for the previous month. The name of the recipient or individual provider, name of the worker, and the date of referral to the investigative unit are listed as the first entries on the new Form H4831.
Number of Copies
An original and one copy of Form H4831 are typed. Legible handwritten entries are also acceptable.
The copy of Form H4831 for the prior month is forwarded to the appropriate program director on the first working day of the new month. The original of Form H4831 becomes a part of a permanent file maintained by the local unit supervisor.
Form H4831 is retained for three years.
Month and Year Being Reported — Enter the month and year which represents the period of this report.
Worker's Name — Enter the name of the worker who prepared and submitted Form H4830 to the local unit supervisor.
Recipient's Name or Individual Provider's Name — Enter the name of the recipient or individual provider as shown on Form 4830.
Not Referred to Investigative Unit — Enter the date on which the supervisor signs Form H4830 to indicate that he or she does not concur with the worker that a referral should be submitted to the investigative unit. In such instances, the supervisor has determined that facts in the case do not support suspected fraud or that departmental policies and procedures have not been correctly applied. Form H4830 and the case folder are returned to the worker. The reason(s) for the nonconcurrence and the appropriate action to be taken are shared with the worker.
Date Forms H1000-B and/or H1018 Sent — Enter the date Forms H1000-B and/or Form H1018 are submitted to the Fiscal Division. This section will be completed:
- When the financial supervisor does not believe fraud is involved, or
- When the investigative unit does not pursue prosecution or collection in a financial services case.
Date Referred to Investigative Unit — Enter the date Form H4830 is signed by the supervisor and forwarded to the investigative unit.
Six columns are provided under "Disposition." As Forms H4834 and 4836 are received from the investigative unit reporting the status of suspected fraud cases under investigation, the supervisor notes the information. The date Form H4834 or H4836 was prepared by the investigative unit is entered on the log in the column which corresponds to the information being reported.
For any recipient or individual provider listed on Form H4831 and whose case was referred for suspected fraud, it is possible to have from one to as many as five entries under "Disposition" up to and through the completion of the investigation into suspected fraud. These might include facts support fraud, referred to law enforcement officials, referred to administrative fraud hearing, repayment arranged or court ordered, and convicted, all of which may extend over a considerable period of time. The name of the recipient or individual provider is carried over from one month to the next on Form H4831 until the investigation into suspected fraud had been completed. When it is necessary to carry over a name, also enter on the new Form H4831 all dates of previous dispositions on the specific case. In this way, each month's Form H4831 reflects any previous dispositions and the current status of every referral forwarded to the investigative unit but in which the investigation into suspected fraud has not been completed.
Facts Do Not Support Fraud — In this column, enter the report date which shows that facts in the recipient or the individual provider case do not support suspected fraud as determined by the investigative unit investigator. In such situations, the worker initiates recoupment procedures or prepares Form H1018, Claim for Repayment from Recipient or Provider.
Facts Support Fraud — In this column, enter the report date which shows that facts support suspected fraud as determined by the investigative unit investigator.
In all such cases, any three of these events follow. First, a case may be referred to law enforcement officials. (Refer to remaining instructions.) Second, although facts are sufficient to support fraud, a case may not be referred. This may occur when it is determined during a consultation between the investigative unit investigator and law enforcement officials that the case is unsuitable for prosecution. Third, the case may be referred to the fraud hearing officer for an administrative fraud hearing. In those cases not referred to law enforcement officials, Form 4834 may indicate the decision was due to small amounts involved, existence in the case of a special hardship, arrangement of voluntary reimbursement, or due to some other reason. In such situations, the same date is entered in the "Not Prosecuted" column. When a voluntary reimbursement is arranged, the information is reported by the investigative unit. The supervisor enters the date of Form H1018 or other reporting form in the "Repayment Arranged of Court Ordered" column of Form H4831.
In any of the above situations when the case is not prosecuted and the local unit supervisor has been informed by the investigative unit of the reason, the investigation into fraud is closed. When the case was not presented for prosecution due to the small amounts involved, the local worker initiates recoupment procedures or prepares Form H1018 for food stamp cases.
Referred to Law Enforcement Officials — In this column, enter the date of Form H4834 which shows that the recipient or individual provider case has been referred to the law enforcement officials for investigation of suspected fraud.
Not Prosecuted — In this column, enter the date of Form H4834 which shows that the recipient or individual provider case was referred to law enforcement officials but the decision was made not to prosecute the individual. If voluntary repayment was arranged with the individual by the law enforcement officials, the appropriate box is marked on Form H4834. However, the local unit supervisor enters the date of Form 1018 in the applicable column of Form 4831 upon receipt of a copy of Form H1018 reporting the terms of repayment. In the event no repayment arrangement was made by the court, recoupment is initialed or Form H1018 is prepared by the local worker.
Payment Arranged or Court Ordered — In this column, enter the date of Form H1018, or Form H4836 if a food stamp recipient convicted of fraud, reporting the terms of repayment which were arranged with the recipient or individual provider or were ordered by the court.
Convicted — In this column, enter the date of Form H1018 or Form H4836 which shows that the recipient or individual provider was convicted of fraud.
Unit Number — Enter the number of the local supervisory unit.
Region — Enter the number of the region in which the local unit is located.
Signature of Supervisor — The supervisor signs both copies of Form H4831.