N.Y. Comp. Codes R. & Regs. tit. 18 § 385.12

Current through Register Vol. 46, No. 45, November 2, 2024

Section 385.12 - Process of eligibility determination

(a) Noncompliance of public assistance applicants and recipients with the requirements of this Part.

(1) Potentially employable applicants and recipients.

(i) An applicant who has been determined to be exempt from participation in work activities in accordance with the requirements of this Part due to being incapacitated due to a physical and/or mental health condition pursuant to this section, who, in the judgment of the social services official has the potential to improve his/her ability to work through suitable medical care, rehabilitation and/or treatment, will be denied assistance if he/she willfully and without good cause fails to comply with requirements for potentially employable applicants pursuant to section 385.2 of this Part. Ineligibility for public assistance continues until the applicant agrees to comply with the requirements and demonstrates such compliance where appropriate.

(ii) A recipient who has been determined to be exempt from participation in work activities in accordance with the requirements of this Part due to being incapacitated due to a physical and/or mental health condition pursuant to this section, who, in the judgment of the social services official has the potential to improve his/her ability to work through suitable medical care, rehabilitation and/or treatment, and willfully and without good cause refuses or fails to comply with the requirements for the potentially employable recipient pursuant to section 385.2 of this Part, is ineligible to receive public assistance until such time as he/she is willing to comply with such requirements.

(2) A public assistance applicant or recipient subject to employment requirements who is determined to have refused or failed to comply with the requirements of this Part in accordance with the provisions of subdivision (a) of section 385.11 of this Part regarding conciliation for individuals not living in a city with a population of one million or more people or subdivision (b) for individuals living in a city with a population of one million or more people must be provided a notice of such determination and of the intent of the social services district to deny, discontinue or reduce assistance, as follows:

(i) An applicant must be issued an adequate notice of denial of public assistance which informs him/her that he/she has refused or failed to comply without good cause with employment requirements in accordance with the provisions of section 385.6(a)(7)(i), section 385.7(a)(7)(i), section 385.9(e)(5) or section 385.13(a)(8)(i) of this Part. An applicant must be issued an adequate notice of denial of public assistance which informs him/her that he/she has willfully refused or failed to comply with employment requirements without good cause in accordance with the provisions of this Part other than those specified in this subparagraph.

(ii) A recipient must be issued an adequate and timely notice of intent to discontinue or reduce assistance which informs him/her that he/she has willfully and without good cause refused or failed to comply with employment requirements in accordance with the requirements of this Part. For recipients who live in a city with a population of one million or more people, the recipient must not have reengaged in work requirements as assigned by the social services district for a minimum of five business days but not more than 10 business days.

(iii) The notices specified in subparagraphs (i) and (ii) of this paragraph must also inform:

(a) the applicant or recipient of the specific instance(s) of refusal or failure to comply willfully and without good cause with the requirements of this Part and of the specific section of this Part in which the requirement(s) is contained;

(b) the applicant or recipient who does not live in a city with a population of one million or more people that he/she has the right to again apply for public assistance at any time, and, for safety net assistance recipients, that he/she may reapply at least 45 days before the end of the sanction period to ensure restoration of benefits immediately following the applicable sanction period provided that the individual is otherwise eligible for public assistance;

(c) the applicant or recipient who does not live in a city with a population of one million or more people of the duration for which he/she will be ineligible for public assistance or for a reduced amount of public assistance in accordance with this section;

(d) the applicant or recipient who lives in a city with a population of one million or more people that he/she has the right to apply for public assistance at any time;

(e) the applicant or recipient who lives in a city with a population of one million or more people that the social services district has determined, based on the information available at the time of the review, that appropriate child care, transportation and accommodations for disability were available at the time of the refusal or failure to participate;

(f) the necessary action that must be taken to avoid a pro rata reduction in public assistance benefits and provide the additional information, for applicants or recipients who live in a city with a population of one million or more people, that they may avoid a pro rata reduction in public assistance benefits by reengaging in work activities as assigned by the social services district for a minimum of five business days but not more than 10 business days; and,

(g) that he/she has the right to a fair hearing in accordance with the provisions of Part 358 of this Title.

(3) Refusal of employment.

(i) In determining whether an applicant's or recipient's refusal to accept an offer of employment constitutes refusal or failure to comply without good cause, a social services official shall consider the report of the employment unit or agency through which the job referral was made, pertinent information supplied by the prospective employer, the explanation of the applicant or recipient for not accepting the offer of employment, and any other pertinent evidence.

(ii) An individual is deemed not to have willfully and without good cause refused or failed to comply with employment program requirements, or is deemed to have good cause for refusing an offer of employment in which such person is able to engage, if the evidence shows that:

(a) the job offer was not bona fide;

(b) the salary or wages were less than the minimum required by law, or the conditions of employment were otherwise contrary to law;

(c) child care necessary for an individual to participate is not available in accordance with Part 415 of this Title;

(d) necessary supportive services are unavailable;

(e) a strike, lockout or other public or private industrial controversy was in progress at the place in which employment was offered;

(f) the job would have been hazardous to the applicant's or recipient's life or health, or there was an absence, if appropriate, of workers' compensation;

(g) the place of employment required unreasonable, based on the standards of the community, travel from the applicant's or recipient's home;

(h) child care plans were temporarily disrupted, making it impossible for the applicant or recipient to report as required;

(i) accepting a job would result in a net loss of cash income for the household and the social services district does not make supplemental payments pursuant to section 352.7(m) of this Title to prevent a net loss of cash income;

(j) the assignment or activity is contrary to law;

(k) a personal or family emergency of substantial nature prevents compliance if the participant has notified the social services district with reasonable promptness of his/her inability to comply;

(l) such refusal is caused by circumstances beyond a participant's control.

(iii) The applicant or recipient is responsible for notifying the social services district of the reasons for failing to comply with an employment requirement and for furnishing evidence to support any claim of good cause.

(b) Noncompliance of SNAP applicants and recipients with work requirements.

(1) If an applicant has, without good cause, refused or failed to comply with a SNAP work requirement pursuant to the requirements of this Part, other than applicant voluntary quit or reduction in work effort pursuant to section 385.13 of this Part, he/she will be denied SNAP benefits. The individual's ineligibility for SNAP continues until the applicant complies with the requirements of this section as assigned by the social services district or documents that he/she has become exempt from SNAP work requirements. If an applicant is disqualified, and he/she is a member of an otherwise eligible household, he/she is treated as a disqualified member of the household during the period of disqualification, under section 387.16(c)(1) of this Title.

(2) If a recipient has, willfully and without good cause, refused or failed to comply with a SNAP work requirement pursuant to the requirements of this Part, he/she will be ineligible to participate in SNAP in accordance with the provisions of this section. If a recipient is disqualified and he/she is a member of an otherwise eligible household, he/she is treated as a disqualified member of the household during the period of disqualification, under section 387.16(c)(1) of this Title.

(3) Prior to notifying the household of the proposed disqualification, the social services district must determine whether good cause for noncompliance exists, in accordance with subdivision (c) of this section.

(4) For SNAP recipients, within 10 calendar days of determining that the non-compliance was willful and without good cause, the social services district must issue a timely and adequate notice of adverse action to the recipient. This notice must specify:

(i) the particular act of noncompliance;

(ii) the proposed period of disqualification;

(iii) that the individual may reapply in order to resume participation in SNAP at the end of the disqualification period; and

(iv) information about ending the disqualification as specified in subdivision (e) of this section. The disqualification period begins with the first month following the expiration of the notice period unless a fair hearing is requested. In such case the disqualification period may not begin until the fair hearing request is withdrawn, the individual fails to appear at a scheduled fair hearing, or a fair hearing decision upholding the social services district's action is issued.

(5) When a member of an applicant household has, without good cause, failed to comply with work requirements pursuant to section 385.3 of this Part, the social services district must inform the household of the individual's denial in the notice of action taken. This notice must specify:

(i) the particular act of noncompliance; and

(ii) that the individual may reapply for SNAP benefits, but must comply with SNAP work requirements as determined by the social services district or document an exemption from SNAP work requirements consistent with section 385.3 of this Part as part of the process for establishing eligibility for SNAP benefits, provided the individual is otherwise eligible.

(6) A voluntary participant in a SNAP employment and training program who is exempt from SNAP work requirements and/or participation in an employment and training program must not be disqualified for failure to comply with the requirements of this Part unless the volunteer is subject to sanction pursuant to paragraph (7) of this subdivision.

(7) Failure of certain SNAP applicants and recipients who are exempt from SNAP work requirements to comply with other work requirements. If a household contains a member who is exempt from work requirements solely because he/she is registered for work under an unemployment compensation work requirement or because he/she is subject to participation in work activities funded under title IV of the Social Security Act, and such individual willfully and without good cause refuses or fails to comply with the work requirements of those programs, such individual must be treated as though he/she has failed to comply with the requirements of this Part.

(c) Good cause for refusal or failure to comply with public assistance and SNAP employment requirements.

(1) The social services official is responsible for determining willfulness and without good cause in those instances where an individual has refused or failed to comply with the requirements of this Part. In determining whether or not the individual's conduct was willful and without good cause, the social services official must consider the facts and circumstances, including information submitted by the individual subject to such requirements. Good cause includes circumstances beyond the individual's control, such as, but not limited to, illness of the individual, illness of another household member requiring the presence of the individual, inability to participate due to a domestic violence situation, a household emergency, or the lack of adequate child care for dependent children under age 13 that is needed for the individual to participate in work activities assigned by the social services district.

(2) For noncompliance with public assistance work requirements by an individual who lives in a city with a population of one million or more people, there shall be no finding of willful and without good cause based on the refusal or failure to comply with a single appointment or work requirement.

(3) The applicant or recipient is responsible for notifying the social services district of the reasons for refusing or failing to comply with an employment requirement and for furnishing evidence to support an alleged exemption from public assistance work requirements, pursuant to section 385.2 of this Part, SNAP work requirements, pursuant to section 385.3 of this Part, or any claim of good cause.

(d) Public assistance sanctions for failure to comply with employment requirements.

An applicant for or recipient of public assistance who willfully and without good cause refuses or fails to comply with employment requirements assigned pursuant to this Part shall be ineligible to receive public assistance for the periods specified in this subdivision. However, such sanctions shall not apply to: an applicant deemed ineligible for public assistance pursuant to section 385.2(c)(1) of this Part; an applicant who is ineligible for public assistance pursuant to section 385.6(a)(7)(i) of this Part; an applicant who is ineligible for public assistance pursuant to section 385.7(a)(7)(i) of this Part; or an applicant who is ineligible for public assistance pursuant to section 385.9(e)(5)(i) of this Part.

(1) In the case of a parent or caretaker of a dependent child, when the parent or caretaker does not live in a city with a population of one million or more people, the public assistance otherwise available to the household of which that individual is a member shall be reduced pro rata as determined by the commissioner of the office:

(i) for the first such refusal or failure to comply, until the individual is willing to comply;

(ii) for the second such refusal or failure to comply, a period of three months and thereafter until willing to comply;

(iii) for the third and all subsequent instances of such refusal or failure to comply, a period of six months and thereafter until willing to comply.

(2) In the case of an individual who is a member of a household without dependent children applying for or in receipt of safety net assistance and who does not live in a city with a population of one million or more people, the public assistance otherwise available to the household of which that individual is a member shall be reduced pro rata as determined by the commissioner of the office:

(i) for the first such refusal or failure to comply, a period of 90 days and thereafter until willing to comply;

(ii) for the second such refusal or failure to comply, a period of 150 days and thereafter until willing to comply;

(iii) for the third such refusal or failure to comply, a period of 180 days and thereafter until willing to comply.

(3) Willing to comply as used in paragraph 1 and paragraph 2 of this subdivision means that an individual, as required by the social services district, reports to and participates in an assigned work activity site or other location on time and prepared to engage in the assigned activity for the number of business days required by the social services district, provided that the number of days required does not exceed 10 business days.

(4) In the case of an individual who lives in a city with a population of one million or more people, the public assistance otherwise available to the household of which that individual is a member shall be reduced pro rata as determined by the commissioner until the individual reengages in work activities as assigned by the social services district for a minimum of five business days, but no more than 10 business days or cooperates with efforts to document that he/she is exempt from work requirements pursuant to section 385.2 of this Part.

(5) In the case of an individual who was the member of a household without dependent children prior to being sanctioned in accordance with the provisions of this subdivision, and who does not live in a city with a population of one million or more people, and for whom the specified sanction period has ended, a reminder shall be sent to such individual indicating an opportunity to end the sanction by complying with employment programs. The commissioner shall establish the language required in the reminder.

(6) In the case of an individual who lives in a city with a population of one million or more people at the time of being sanctioned for noncompliance with public assistance work requirements in accordance with the provisions of this subdivision, and for whom the public assistance sanction has continued for 30 or more days, a reminder shall be sent to such individual indicating an opportunity to end the sanction by complying with employment programs or by documenting that he/she has become exempt consistent with section 385.2 of this Part. The commissioner shall establish the language required in the reminder.

(e) SNAP sanctions for failure to comply with employment programs.

(1) An applicant who is required to participate in work activities who, without good cause, fails to comply with the requirements of this section shall be denied participation in SNAP until such time as he/she complies with SNAP work requirements as determined by the social services district or documents an exemption from SNAP work requirements consistent with section 385.3 of this Part. This provision does not apply in the case of a voluntary quit or a voluntary reduction in work effort without good cause, as described in section 385.13 of this Part, by a SNAP applicant who is subject to SNAP work requirements.

(2) The needs of a recipient who is required to participate in work activities and who has, willfully and without good cause, failed to comply with the requirements of this section will not be considered in determining the needs of his/her household for SNAP for the following time periods:

(i) for the first instance of willful failure to comply without good cause, a period of one month and thereafter until the individual complies with the requirements of this section as determined by the social services district;

(ii) for the second instance of willful failure to comply without good cause, a period of three months and thereafter until the individual complies with the requirements of this section as determined by the social services district; and

(iii) for the third and all subsequent instances of willful failure to comply without good cause, a period of six months and thereafter until the individual complies with the requirements of this section as determined by the social services district.

(3) Following the end of the disqualification period for noncompliance with the requirements of this Part, a household may request that the disqualified individual be added to the household and resume participation. The social services district must act on this request in accordance with section 387.17(e)(6) of this Title.

(4) Eligibility may be reestablished during the disqualification period if the participating household requests that the disqualified individual be added to the household, and the disqualified individual becomes exempt from the work requirement pursuant to section 385.3 of this Part.

(5) A disqualification for noncompliance with work requirements may be ended, after the time periods specified in paragraph (2) of this subdivision, if the disqualified individual complies with the requirement which caused the disqualification or an alternate work assignment as determined by the social services district.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 385.12

Amended, New York State Register December 3, 2014/Volume XXXVI, Issue 48, eff. 12/29/2014

Amended New York State Register January 9, 2019/Volume XLI, Issue 02, eff. 1/15/2019