Form FNS-380 Worksheet for SNAP Quality Control Reviews

OMB 0584-0074, APPENDIX B

OMB APPROVED NO. 0584-0074
Expiration Date: XX/XX/XXXX

U.S. DEPARTMENT OF AGRICULTURE - Food and Nutrition Service

WORKSHEET FOR QUALITY CONTROL REVIEWS
PRIVACY ACT NOTICE: This report is required under provisions of
7 CFR 275.14 (SNAP). This information is needed for the review of State
performance in determining recipient eligibility. The information is used
to determine State compliance and failure to report may result in a finding
of non-compliance.

OMB STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0584-0074. The
time required to complete this collection is estimated to average 8.9 hours per response,
including the time to review instructions, search existing data sources, gather the data needed,
and complete and review the information collection.

A. IDENTIFYING INFORMATION

B. PERSONS LIVING IN THE HOME

1. LOCAL AGENCY
2. CASE NAME
3. ADDRESS

NAME

BIRTH DATE

6. CASE NUMBER

SOCIAL
SECURITY
NUMBER

SNAP
RECIPIENT

C. SIGNIFICANT PERSONS NOT LIVING IN THE HOME

7. REVIEW NUMBER

RELATIONSHIP
OR
SIGNIFICANCE

NAME

From:

PART. DURING SAMPLE MONTH
REC'D EXPEDITED SERVICE
CATEGORICALLY ELIGIBLE HH
REVIEWER
DATE ASSIGNED
DATE OF CASE READING
DATE OF INTERVIEW
DATE COMPLETED
SUPERVISOR
DATE CLEARED

FORM FNS-380 (03-13) Previous Editions Obsolete

SOCIAL
SECURITY
NUMBER

ADDRESS

PHONE
NUMBER

FINANCIAL
SUPPORT

11
12
13
14
15

To:

12.
13.
14.
15.
16.
17.
18.
19.
20.
21.

RELATIONSHIP
OR
SIGNIFICANCE

1
2
3
4
5
6
7
8
9
10

4. PHONE NUMBER
5. DIRECTIONS TO LOCATE

8. REVIEW DATE
9. RESERVED
10. MOST RECENT ACTION
a. Date
b. Type
11. CERTIFICATION PERIOD

AGE

YES

NO

YES

NO

YES

NO

D. REVIEW FINDINGS
ALLOTMENT

AMOUNT CORRECT

UNDERISSUANCE

OVERISSUANCE

INELIGIBLE

AMOUNT IN ERROR

SBU

Electronic Form Version Designed in Adobe 10.0 Version

Page 1

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

110 AGE

BASIC PROGRAM REQUIREMENTS (100)

1 = No error
2 = Agency error
3 = Client error

111 STUDENT STATUS

1 = No error
2 = Agency error
3 = Client error

130 CITIZENSHIP AND NONCITIZEN STATUS

1 = No error
2 = Agency error
3 = Client error

140 RESIDENCY

1 = No error
2 = Agency error
3 = Client error

Page 2

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

150 HOUSEHOLD COMPOSITION

1 = No error
2 = Agency error
3 = Client error

151 RECIPIENT DISQUALIFICATION

1 = No error
2 = Agency error
3 = Client error

WORK REQUIREMENTS
160 EMPLOYMENT & TRAINING
PROGRAMS

1 = No error
2 = Agency error
3 = Client error

161 TIME LIMITED PARTICIPATION
1 = No error
2 = Agency error
3 = Client error

162 WORK REGISTRATION
1 = No error
2 = Agency error
3 = Client error

163 VOLUNTARY QUIT/REDUCING
WORK EFFORT

1 = No error
2 = Agency error
3 = Client error

Page 3

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

164 WORKFARE AND COMPARABLE
WORKFARE

1 = No error
2 = Agency error
3 = Client error

165 EMPLOYMENT STATUS/JOB
AVAILABILITY

1 = No error
2 = Agency error
3 = Client error

166 ACCEPTANCE OF EMPLOYMENT

1 = No error
2 = Agency error
3 = Client error

170 SOCIAL SECURITY NUMBER

1 = No error
2 = Agency error
3 = Client error

LIQUID RESOURCES
211 BANK ACCOUNTS OR CASH
ON HAND

RESOURCES (200)

1 = No error
2 = Agency error
3 = Client error

Page 4

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

212 NONRECURRING LUMP-SUM
PAYMENTS

1 = No error
2 = Agency error
3 = Client error

213 OTHER LIQUID ASSETS

1 = No error
2 = Agency error
3 = Client error

NON-LIQUID RESOURCES

1 = No error

221 REAL PROPERTY
2 = Agency error
3 = Client error

222 VEHICLE

1 = No error
2 = Agency error
3 = Client error

Page 5

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

224 OTHER NON-LIQUID RESOURCES

1 = No error
2 = Agency error
3 = Client error

225 COMBINED RESOURCES

1 = No error
2 = Agency error
3 = Client error

Page 6

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

EARNED INCOME

INCOME (300)

1 = No error

311 WAGES AND SALARIES
2 = Agency error
3 = Client error

312 SELF-EMPLOYMENT

1 = No error
2 = Agency error
3 = Client error

Page 7

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

314 OTHER EARNED INCOME

1 = No error
2 = Agency error
3 = Client error

EARNED INCOME DEDUCTIONS

1 = No error

321 EARNED INCOME DEDUCTIONS
2 = Agency error
3 = Client error

323 DEPENDENT CARE DEDUCTIONS
1 = No error
2 = Agency error
3 = Client error

Page 8

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

UNEARNED INCOME

1 = No error

331 RSDI BENEFITS
2 = Agency error
3 = Client error

332 VETERANS BENEFITS
1 = No error
2 = Agency error
3 = Client error

333 SSI AND/OR STATE SSI
SUPPLEMENT

1 = No error
2 = Agency error
3 = Client error

334 UNEMPLOYMENT
COMPENSATION

1 = No error
2 = Agency error
3 = Client error

Page 9

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

335 WORKER'S COMPENSATION

1 = No error
2 = Agency error
3 = Client error

336 OTHER GOVERNMENT BENEFITS
1 = No error
2 = Agency error
3 = Client error

342 CONTRIBUTIONS
1 = No error
2 = Agency error
3 = Client error

343 DEEMED INCOME
1 = No error
2 = Agency error
3 = Client error

Page 10

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

344 TANF, PA or GA

1 = No error
2 = Agency error
3 = Client error

345 EDUCATIONAL GRANTS/
SCHOLARSHIPS/LOANS

1 = No error
2 = Agency error
3 = Client error

346 OTHER UNEARNED INCOME
1 = No error
2 = Agency error
3 = Client error

350 CHILD SUPPORT PAYMENTS
RECEIVED FROM ABSENT
PARENT

1 = No error
2 = Agency error
3 = Client error

Page 11

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

OTHER DEDUCTIONS

1 = No error

361 STANDARD DEDUCTION
2 = Agency error
3 = Client error

363 SHELTER DEDUCTION

1 = No error
2 = Agency error
3 = Client error

364 STANDARD UTILITY ALLOWANCE

1 = No error
2 = Agency error
3 = Client error

Page 12

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

365 MEDICAL DEDUCTION

1 = No error
2 = Agency error
3 = Client error

366 CHILD SUPPORT PAYMENT
DEDUCTION

1 = No error
2 = Agency error
3 = Client error

371 COMBINED GROSS INCOME

1 = No error
2 = Agency error
3 = Client error

372 COMBINED NET INCOME

1 = No error
2 = Agency error
3 = Client error

Page 13

ELEMENTS OF ELIGIBILITY AND PAYMENT DETERMINATION

REVIEW NO.

ELEMENTS OF ELIGIBILITY
AND BASIS OF ISSUANCE

QC ANALYSIS OF CASE RECORD
(Pertinent facts, sources of
verification, reliability, gaps
or deficiencies)

FINDINGS OF FIELD INVESTIGATION
(Facts obtained, verification and
substantiation, nature of errors)

RESULTS

(1)

(2)

(3)

(4)

520 ARITHMETIC COMPUTATION

1 = No error
2 = Agency error
3 = Client error

530 TRANSITIONAL BENEFITS
1 = No error
2 = Agency error
3 = Client error

560 REPORTING SYSTEM

1 = No error
2 = Agency error
3 = Client error

810 SNAP SIMPLIFICATION
PROJECT

1 = No error
2 = Agency error
3 = Client error

820 DEMONSTRATION PROJECTS

1 = No error
2 = Agency error
3 = Client error

Page 14

Source

Wages, salaries, Federal workstudy minus allowable
expenses, or other income from employment. (Do not
count excluded income)

Member

:
:
:
:

1. Add Line K from Self-Employment
addendum sheet (if applicable) and
all earned income listed above.
Educational grants, scholarships, or loans
(except Federal workstudy)
2. Enter monthly income received from
educational grants, etc..
3. Enter monthly tuition and mandatory
fees and other allowable expenses.
4. Subtract 3 from 2.
5. Add lines 1 and 4.
Unearned income (Do not count excluded income)

:
:
:
6. Total unearned income.
Gross monthly income
7. Add lines 5 and 6.
8. Enter net loss from line K,
if applicable.
9. Subtract line 8 from 7. (Result
is gross monthly income.)
10. Enter appropriate gross
income eligibility limit.
Go to line 11 only if:
- line 9 is less than or equal to line 10; or
- household contains an elderly/disabled member; or
- household is categorically eligible for SNAP Benefits.
DEDUCTIONS: (Other than shelter)
11. Multiply line 1 by 20% and enter
result here.
12. Subtract 11 from 9.
13. Enter standard deduction.
14. Subtract line 13 from 12.
15. Enter medical costs over limit for
household with elderly/disabled member.
16. Subtract line 15 from 14.
17. Enter dependent care costs
(not to exceed authorized limit).
18. Subtract line 17 from 16.
19. Enter child support.
20. Subtract line 19 from 18.

ELIGIBILITY
WORKER

(2)

FINAL SAQC
DETERMINATION

QUALITY CONTROL
COMPUTATION SHEET

(1)

(3)

(4)

(5)

Page 15

21. Enter homeless shelter deduction, if
applicable.
22. Subtract 21 from 20.
23. If household had shelter costs, and did
not receive a homeless shelter deduction
divide line 22 by 2.
SHELTER COSTS: (Use either the utility standard or
the actual cost of each utility bill.)
Rent or mortgage
Taxes and insurance
Total utility standard
Telephone (Basic rate)
Electric
Gas
Oil
Water and Sewage
Garbage and trash
Installation of utilities
Other
24. Total shelter costs
25. Enter amount from line 23.
26. Subtract line 25 from 24 (Result
equals excess shelter costs).
27. If no elderly/disabled member, enter
the maximum limit for the shelter
deduction.
NET MONTHLY INCOME
28. Enter amount from line 20 (income
after all deductions except shelter)
29. If elderly/disabled member, enter line
26. For all other households, enter
amount from line 26 or 27, whichever
is less.
30. Subtract line 29 from 28. (Result
equals net monthly income.)
31. Enter appropriate net income
eligibility limit.
Go to line 32 only if:
-- Line 30 is less than or equal to line 31; OR
-- all members of the HH are categorically eligible.
ALLOTMENT LEVEL
32. Enter Thrifty Food Plan for household
size.
33 Multiply line 30 by 30% and enter
result here.
34. Subtract line 33 from 32; (prorating or
applying minimum allotment if
required.)

ELIGIBILITY
WORKER

(2)

FINAL SAQC
DETERMINATION

QUALITY CONTROL
COMPUTATION SHEET

(1)

(3)

(4)

(5)

Page 16

SOURCE

(1)

ELIGIBILITY
WORKER

(2)

FINAL SAQC
DETERMINATION

(3)

QUALITY CONTROL
COMPUTATION SHEET
SELF-EMPLOYMENT ADDENDUM
FOR HOUSEHOLDS WITH SELF-EMPLOYMENT I
INCOME: START AT STEP A AND WORK THROUGH
STEP K. DO THE STEPS IN ORDER. IF A NEGATIVE
NUMBER RESULTS AFTER SUBTRACTING TWO
NUMBERS, INSERT ZERO, EXCEPT LINES O, J, AND
K.

:

FARM SELF-EMPLOYMENT INCOME
HOUSEHOLD MEMBERS

:
:
A. Total monthly gross farm
self-employment income
B. Enter monthly farm business costs
SUBTRACT LINE B FROM LINE A, AND:
C. If gross income exceeds costs
enter figure here as not farm gain.
D. If business costs exceed gross
income, enter figure here as net
farm gain.

SELF-EMPLOYMENT INCOME OTHER
THAN FARMING (Include room and
board payments)

:
:
:
E. Total monthly gross self-employment
income other than farming.
F. Enter monthly farm self-employment
income from line C (If Applicable)
G. Add lines E and F. (Result is total
self-employment income.)
H. Enter monthly business cost
other than farming.
I. Subtract line H from G. (Result is
net monthly self-employment income
before taxes; (If Less Than O, Enter 0.)
J. Enter net farm loss from line D
(If none, enter 0)
K. Subtract line J from I. Enter as a
positive number, a negative number
or 0.

If line K shows a net gain, add to wages and salaries on line 1 and enter 0 on line 8 of the Computation Sheet.

(4)

If Line K shows a net loss, enter amount on line 8 of the Computation Sheet and make no entry for self-employed income on line 1.

(5)

Page 17

GENERAL

INSTRUCTIONS FOR COMPLETING FORM FNS-380,
THE WORKSHEET FOR SNAP PROGRAM
QUALITY CONTROL REVIEWS

FNS HANDBOOK 310

The standard worksheet appears in this Handbook in Appendix B. The automated worksheet may be downloaded from the USDA
SNAP Quality Control homepage at the following address: http://www.fns.usda.gov/snap/qc/default.htm. The users manual for the
automated worksheet follows the FNS 380 form and the instructions for filling in the form.
Some States have designed their own worksheet for SNAP’s Quality Control (QC) reviews. These States must submit for
approval their designed worksheets to the FNS regional office (RO). The worksheet will be reviewed and States will then be
notified of the decision.

FACESHEET – PAGE 1 (FNS-380)
This is page one of the Worksheet for SNAP Quality Control reviews. There are four sections:
• Section A, is for identifying information and tracking information about the QC review.
• Section B, lists persons living in the home.
• Section C, lists significant persons not living in the home.
• Section D, is a summary of the review findings.

SECTION A – IDENTIFYING INFORMATION
1. Agency - Enter name of local agency.
2. Case Name - Enter the name of the recipient by which the case is identified.
3. Address - Enter the complete address at which the recipient resides.
4. Telephone Number - Enter the telephone number at which the recipient can be reached.
5. Directions to Locate - Enter the directions to the address where the recipient resides. (This is particularly significant where
the mailing address is a post office box number or rural route number.)
6. Case Number - Enter the number assigned by the local agency to identify the household that was certified.
7. Review Number - Enter the number assigned to the Quality Control Review.
8. Review Date/Month - Enter month, day, and year for which case eligibility and benefit level were reviewed.
9. Reserved - Leave blank.
10. Most Recent Action: Date and Type - Enter the effective date (month, day, and year) of the most recent certification or
recertification action prior to or concurrent with the review date. This date cannot be prior to the start of the most recent
certification period.
• A certification means the first time a case has been certified or a certification action following a break in participation.
• A recertification means the initial certification period has expired and the agency has (a) completed a reexamination
of all factors of eligibility subject to change following a period of time during which the recipient has been determined
eligible and (b) made a decision to continue eligibility.
11. Certification Period - Enter the period for which the case was certified.
12. Participated During Sample Month - Check (¥) the appropriate box to indicate if the household participated during the
sample month.
13. Received Expedited Service - Check (¥) the appropriate box to indicate if the household was certified using expedited
service procedures.
14. Categorically Eligible Household - Check (¥) the appropriate box to indicate whether the household was categorically
eligible.
15. Reviewer - Enter the name of the QC reviewer conducting the review and/or the reviewer’s identification number.

16. Date Assigned - Enter the month, day and year the sample case was received by the QC reviewer.

FNS HANDBOOK 310

17. Date of Case Readings - Enter the month, day and year the QC reviewer read the local office record of the recipient.
18. Date of Personal Interview - Enter the month, day and year a personal interview was held with the recipient.
19. Date Completed - Enter the month, day and year the Quality Control review was completed.
20. Supervisor - Enter the name of the QC reviewer’s supervisor(s).
21. Date Cleared - Enter the month, day and year the review was cleared by the supervisor for statistical processing.

SECTION B – PERSONS LIVING IN THE HOME
Name - Enter the names of all persons living in the household. These would include the recipient, and both related and unrelated
persons, including roomers and boarders. The first person listed should be the head of the household.
If additional space is needed, use the reverse side of the facesheet. For additional space on the automated worksheet, press
enter on the button labeled “Click for more HH members”.
Birth Date - Enter the birth dates of all persons listed as members of the SNAP household.
Age - Enter the age of all persons listed as members of the SNAP household.
Relationship or Significance - Enter letters to show the relationship of the household members to the head of the household
such as:
• SP - spouse
• S - son
• D - daughter
• GS - grandson
• N - niece
• FR - friend, etc.
Note: If the person is not included in the SNAP household under review but is a SNAP recipient indicate the case number under
which he/she is receiving SNAP benefits.
Social Security - Enter the social security number of each household member. Enter “unknown” if the number cannot be
determined from the case record or field investigation. Enter “none” if it is known that the household member never had a social
security number.
Recipient - Indicate whether the agency included this person in the sampled household.

SECTION C – SIGNIFICANT PERSONS NOT LIVING IN THE HOME
Name - Enter the names of all persons, including responsible relatives not residing in the household, living or dead, who are of
significance to the members of the SNAP benefit household. This includes all absent parents (and alleged parents) of children in
the household whether or not they are known to contribute to the person’s support.
If the identity of the absent parent of a member of the household listed in Section B is unknown write “father/mother unknown” in
this column and indicate the line number of the member in Section B.
Relationship or Significance - Enter the relationship of each person to the member of the household listed in Section B, and
identify by line number, the individual to whom the relationship pertains.
Social Security Number - Enter the social security number (SSN), if known, of persons listed in this section.
• Enter “unknown” if the number cannot be determined from the case record or field investigation.
• Enter “none” if it is known that the person never had a SSN.
Address - Enter the address of each person listed. If the address cannot be determined either from the case record or from the
field investigation enter “unknown”.
Phone Number - Enter the telephone number of each person listed.
Financial Support - Check (¥) this box for any person who provided financial support to a member of the SNAP benefit
household during the budget or review month.

SECTION D – REVIEW FINDINGS

FNS HANDBOOK 310

This section provides a brief summary of the review findings. Enter the allotment amount authorized for the review month. (See
section 232.) Check (¥) the box that corresponds to the findings of the review of the case. If an error exists, enter the amount of
the error.

WORKSHEET NARRATIVE- PAGES 2 THROUGH 14 (FNS-380)
GENERAL INSTRUCTIONS
Use the remaining portion of the worksheet to document each step of the independent full-field investigation and to evaluate each
step in determining eligibility and appropriate benefit level. Record the facts sufficiently to establish the basis on which the
decision was made on each element.

COLUMN 1, ELEMENTS OF ELIGIBILITY AND BASIS OF ISSUANCE
Listed are a number of elements associated with eligibility and benefit level. Definitions of these elements and verification
requirements are found in Chapters 8 through 11. States may add, under each area, any additional State eligibility requirements
not included herein.

COLUMN 2, QC ANALYSIS OF CASE RECORD
Use this column to record documentation contained in the case record and to assist in planning for the field investigation. Enter
details of recorded information that need not be reverified in this column. Note any pertinent facts; also record whether anything is
questionable about the information. Identify questions that pertain to some but not all persons in the family. Indicate any of the
following: conflicts in information recorded, factors subject to change, reliability of information recorded, reliability of source used,
and missing information.
Use this column selectively to highlight other points to be considered when conducting the field investigation or to remind you of
the case situation.

COLUMN 3, FINDINGS OF FIELD INVESTIGATION
Record the results of the field investigation. Information in this column provides the basis for completing the review findings and
detailed error finding portions of the QC Review Schedule. The QC review is a review of the validity of the case at a given point in
time in accordance with the provisions of Federal law, regulations, and implementing memoranda. Therefore, the entries in this
column will relate to the facts of the situation affecting eligibility as of the review date even though the specific findings may or
may not constitute a case error.
Answer any questions raised in Column 2 in this section. Entries such as “correct”, “verified”, and “OK” do not constitute adequate
information. Document the specific sources used as verification or any attempts to verify the element for all applicable elements
of eligibility and basis of issuance. Information must be provided in sufficient detail for anyone reviewing the case at a later time to
clearly understand the conclusions on each element and the final conclusions on the case.
Where there are eligibility or basis of issuance variances based on circumstances as of the review date, record the date the
variances first occurred.

COLUMN 4, RESULTS
Complete each element by circling one of the following to indicate the final decision:
1 = No error
2 = Agency error
3 = Client error
An agency error is defined as the failure of the agency to discharge its responsibilities in a proper and timely manner.
A client error is defined as the failure of the recipient, guardian, or authorized representative to provide correct information or to
otherwise discharge his/her responsibility in a proper and timely manner.
Where both the agency and the client are responsible for the same error in an element the agency error takes precedence on the
basis that the client’s failure would have been negated, and no discrepancy would have existed had the agency acted proper.

COMPUTATION SHEETS – PAGES 15 THROUGH 17 (FNS-380)
General Instructions

FNS HANDBOOK 310

The computation sheets are to be used to document all completed active case reviews. The only exceptions are reviews of
households that were ineligible for reasons other than income. Columns (1) and (2) are required to be completed, Columns (3),
(4) and (5) are optional. Regardless of the use of Columns (3), (4), and (5), Columns (1) and (2) must be used as outlined below.

COLUMN 1, ELIGIBILITY WORKER
Column (1), record the figures that the eligibility worker used to compute the allotment for the sample month.

COLUMN 2, FINAL SAQC DETERMINATION
Column (2), record the final quality control determination figures based on the results of the review.
Note: If the household was ineligible because of gross or net income the reviewer may stop at the appropriate income line.

COLUMNS 3, 4, 5
Columns (3), (4), and (5) of the computation sheets are optional. They are included for the convenience of States and may be
used for recording:
• Comparison I
• Comparison II
• Illustrating the impacts of individual variances
• Reflecting a retrospectively budgeted household’s prospective eligibility
• Any other State identified purpose