3.11.29 Health Coverage Tax Credit (HCTC) Enrollment Processing

Manual Transmittal

July 05, 2017

Purpose

(1) This transmits new IRM 3.11.29

(2) This IRM is used by employees of the Enrollment Team in Entity at the Austin Submission Processing Center. The enrollment team evaluates eligibility for the monthly advance payment of the Health Coverage Tax Credit (HCTC), enters information from Form 13441-A into a database, and authorizes payment of the credit.

Material Changes

(1) IRM 3.11.29 was created for the HCTC Enrollment Team in Austin.

Effect on Other Documents

This IRM renders IRM 25.19.1, 25.19.2, 25.19.3, 25.19.4, 25.19.5, and 25.19.6 obsolete.

Audience

Employees in the Austin Submission Processing Center and Customer Service Representatives in Accounts Management.

Effective Date

(07-05-2017)


Linda J. Brown
Director of Submission Processing
Wage and Investment Division

Background

  1. The Health Coverage Tax Credit, authorized in the Trade act of 2003, first became effective for tax year 2002 and expired at the end of tax year 2013. The Trade Preferences and Extension Act of 2015 restored it retroactively to January 1st, 2014, erasing the hiatus in its duration, and extended to it the end of tax year 2019, when it expires again.

  2. The Health Coverage Tax Credit (HCTC) subsidizes most of the cost of qualified health insurance for eligible individuals and their eligible family members. The credit pays 72.5% of the insurance premiums; the person enrolled in the program pays 27.5% of the premiums.

  3. Eligibility for the HCTC is restricted to two groups of individuals:

    1. individuals who because of a qualifying job loss are eligible for benefits under the program Trade Adjustment Assistance (TAA) and receive benefits through the Trade Readjustment Allowance (TRA), Reemployment Trade Adjustment Assistance (RTAA), or Alternative Trade Adjustment Assistance (ATTA)

    2. individuals who are between 55 and 64 years old and whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation (PBGC) and are not enrolled in Medicare

    3. individuals eligible for the HCTC are allowed the tax credit only if they couldn’t enroll in certain other health coverage (Medicaid, for instance) or aren’t eligible for other specified coverage (Medicare Part A, for instance).

  4. To apply for the HCTC, applicants submit Form 13441-A, Monthly Registration and Update, and the required supporting documents named in Form 13441-A. They mail the packet to mail stop 6098 AUSC, Austin, TX 78741.

Deviations from the IRM

  1. Service Center Directors, Headquarter Branch Chiefs, and Headquarter Analysts do not have the authority to approve deviations from IRM procedures. Any request for an exception or deviation to an IRM procedure must be elevated through appropriate channels for executive approval. This will ensure that other functional areas are not adversely affected by the changes and that it does not result in disparate treatment of taxpayers.

  2. See guidelines in IRM 1.11.2, Internal Management Documents System, InternalRevenueManual(IRM)Process. Request for an IRM deviation must be submitted in writing and signed by the Field Director, following instructions from IRM 1.11.2.2.4(3). Any disclosure issues will be coordinated by the Program Owner. No deviations can begin until they are reviewed by the Program Owner and approved at the Executive Level. All requests must be submitted to the Submission Processing Headquarters IRM Coordinator.

Program Scope and Objectives

  1. Purpose: This IRM covers information on Health Coverage Tax Credit (HCTC).The enrollment team evaluates eligibility for the monthly advance payment, enters information from Form 13441-A into a database, and authorize payment of the credit.

  2. Audience: The HCTC Enrollment Team, in Austin, is the primary user of this IRM.

  3. Policy Owner: The Director of Submission Processing

  4. Program Owner: Wage and Investment (W&I) Submission Processing

  5. Primary Stakeholders: The HCTC Enrollment Team in Austin

  6. Program Goals: The information contained in this IRM provides the HCTC Enrollment team instructions to evaluate eligibility for the monthly advance payments of HCTC.

Processing Form13441-A, HealthCoverageTaxCredit,MonthlyRegistrationandUpdate

  1. Two operations in Submission Processing play a part in processing Form 13441-A.

    1. Receipt and Control Operation (RCO)
      Clerks in Receipt and Control receive, extract, stamp the received date on, and batch form 13441-A.
      RCO routes Form 13341-A to AUSC 6098 at the Austin Service Center.

    2. Document Perfection Operation (DPO)
      Clerks in Entity batch Form 13441-A
      Tax examiners and quality reviewers in Document Perfection screen enrollment forms, evaluating the completeness of submissions and determining any need for correspondence. Quality reviewers evaluate Form 13341-A accepting the application, corresponding for the correction of defects in the application, or rejecting the application.
      Tax examiners in the Enrollment Team in Entity Austin evaluate Form 13441-A, accepting the application, corresponding for the correction of defects in the application, or rejecting the application.

  2. Batching Form 13441-A in BBTS Entity

    1. Separate new Forms 13441-A from updated Forms 13441-A and batch each separately.

      Note:

      Applicants who update their registration check box 6 on page 1 of Form 13441-A.

    2. Follow instructions in IRM 3.10.5.6.1, "Batch Creation Screen," for creating batches

    3. Batch by received date. Each form in the batch must have the same received date.

    4. Batch Form 13441-A in groups of 25.

    5. Use program 390-84330 for batching new applications.

    6. Use program 390-84331 for batching updated applications.

    7. Use program 390-84332 for batching inquiries with Form 4442 or from US Bank.

    8. Use program 390-84333 for batching Forms 13441-A with Correspondence (suspense)

    9. Use program 390-84334 for batching Forms 13441-A with a reply to correspondence.

    10. Use program 390-84335 for batching Forms 13441-A without a reply to correspondence.

    11. Print batch transmittals and associate the transmittals with their batches.

    12. Stage batches by received date in the designated work area.

  3. Releasing batches Clerks:

    1. Clerks review Form 13441-A before releasing it to Files. Verify that all pages of Form 13441-A are present, supporting documents are attached to Form 13441-A and the PIN (participant identification number) is written on the first page of Form 13441-A or appears in a label on the first page.

      Note:

      Some applicants omit page 1, "General Instructions" and "Required Supporting Document," and submit page 2 through 4 only. Page 1 isn’t required, and Form 13441-A isn’t considered incomplete if it’s missing. Form 13441-A must appear first in any packet released to Files.

    2. Releasing Form 13441-A and associated documents to Files.

    3. Monthly Registration, Update, and Payment of the Health Coverage Tax Credit (HCTC)

    4. Place each batch of 50 Forms 13441-A, along with the Form 9856 and the two copies of Form 3210 for the batch, into a gusset folder. Write on the gusset folder the range of PINs, the program name "HCTC," and tax year of the applications. Follow local procedures for an incomplete range of PINs.

  4. All processed Form 14095 must be stapled to the back of the participants Form 13441-A.

Processing Form 14095 (HCTC Reimbursement Request Form)

  1. Taxpayers can request reimbursement for premiums they paid while waiting to be accepted into the advance monthly program. Form 14095 Health Coverage Tax Credit Reimbursement Request Form, is used to request reimbursement. Forms are stamped and then sent to the HCTC Coordinator.

  2. Check the monthly payment files on the HCTC Sharepoint for months claimed to determine if a payment was made for the participant.

  3. Search the requestor in the HCTC database. Write the participant ID number in the top right hand corner of the form. If the participant is not enrolled, HCTC Coordinator should hold for a week to see if the participant becomes enrolled. Go to step 6 for ineligibility instructions.

  4. On the 15th and 30th of each month, the HCTC Coordinator will forward the spreadsheet to the public mailbox (CFOBFC.InvoiceLink@irs.gov) to be processed. It is not necessary to include the forms or backup.

  5. CFO will acknowledge disbursement. If no confirmation after one month after submission, HCTC Coordinator should inquire.

Form 14095 Determining Eligibility and Request Reimbursement (Part 2)

  1. Verify the following from the form and information in the HCTC database

    1. The participant was eligible for the requested reimbursement month(s) while they were enrolling in the advance monthly program (AMP) or chose not to be in the AMP dating back to January 2017, the first month of the systemic advance monthly program.

      Note:

      This reimbursement does not date back to the beginning of the interim AMP

    2. The reimbursement months requested were for months the participant did not receive monthly program payments through their Health Plan Administrator.

    3. The calculated monthly totals in the HCTC database. Use the reconciliations spreadsheet if needed.
      Scenario 1: Participant paid 27.5% to lockbox and then found they were ineligible for AMP.
      Scenario 2: Participant was not in the program but qualified for the months requested.
      Scenario 3: Spouse of participant was qualified but participant or spouse aged out before enrollment

Form 14095 Supporting Documents (Part 3)

  1. A health insurance bill or payment coupon from HPA for the months identified in part 2 is provided.

  2. These documents must provide the:

    1. name of the participant

    2. SSN of the policyholder who’s not the requester and

    3. monthly premium and

    4. evidence of full payment of premiums, such as bank statement, copies of checks, credit card statements or receipts for money orders

  3. Proof of payment must indicate the amount paid and to whom it was paid.

  4. If the participant is not eligible for a retroactive payment, leave notes in AMS or the database specifically stating why they are not eligible. Correspond with letter 4510.

  5. Attach form and letters to the back of the participant’s original Form 13441-A.

Form 14095 Signatures (Part 4)

  1. Form 14095 must be signed. If not signed return to participant for signature.

  2. Correspond for missing signature. Leave notes in the AMS database and specially state what is missing.

  3. Correspond with missing letter 4511. File on suspense wall by date of form receipt.

Replies to Form 14095

  1. Review reply received from participant.

  2. Review reply, HCTC database, notes on the account and reason for correspondence.

  3. If the provided documentation resolves all of the issues correspondence for example for all retroactive payments or missing signatures add the participant to the Beckley Financial Center spreadsheet

    Note:

    Only one correspondence will be sent.

    .

  4. If the documentation does not resolve the requirements, leave notes in AMS and the database stating why the request cannot be completed. Send to files

  5. Staple the correspondence to the back of the participant’s original Form 13441-A behind Form 14095.

Reporting Time Organization Function Program (OFP)

  1. Report all time spent in processing or handling Form 13441-A processing with the program and function codes (OFP) below.

    OFP Code Function
    390-84310 HCTC14095 Original F14095
    390-84311 HCTC14095 F14095corr
    390-84312 HCTC14095RPY F14095repy
    390-84313 HCTC14095NORP F14095norepy
    390-84330 HCTC New applications Form 13441-A
    390-84331 HCTCUPDT Updated applications Form 13441-A
    390-84332 HCTC4442 Inquiries with Form 4442 and from US Bank
    390-84333 HCTCCOR Correspondence Form 13441-A
    390-84334 HCTCRPLY Reply to correspondence Form 13441-A
    390-84335 HCTCNORPLY No reply to correspondence Form 13441-A
    770-84310 Clerical Clerical Form 14095
    770-84330 Clerical Clerical Form 13441-A

Determining Eligibility and Initial Review of Form 13441-A

  1. Start initial review of Form 13441-A by checking out a batch of Fom 13441-A

  2. Open the database.

  3. The warning that the database is for authorized use only appears. Accept the terms of use by clicking on the button Accept.

  4. Stamp your examiner number in the upper left of the first page of Form 13441-A.

    Note:

    Some applicants omit page 1, General Instructions and Required supporting document, and submit page 2 through 4 only. Page 2 is then the first page of the application.

  5. Before processing Form 13441-A verify that the applicant signed Form 13441-A.

  6. Edit a Received Date on the first page of Form 13441-A, if missing.

  7. The signature must appear under the jurat—"Under penalty of perjury…"—and above the phrase "Privacy Act and Paperwork Reduction Act Notice." Form 13441-A is unacceptable if it’s signed outside this area. Consider such a Form 13441-A unsigned and follow the procedures, in paragraph b, for the unsigned Form 13441-A.

  8. Accept a faxed, digital or photocopied signature.

  9. Accept a signature by a third party to whom the applicant has granted power of attorney (PoA). Form 2848, "Power of Attorney and Declaration of Representative," names the third party and may be present in the packet. If Form 2848 isn’t part of the packet look for the POA with command code CFINQ. If the applicant hasn’t granted power of attorney to the person who signed the Form 13441-A consider Form 13441-A unsigned and follow the procedures, in paragraph a, for the unsigned application.

  10. An applicant with an IRSN or ITIN is ineligible for the HCTC. Follow the procedures below, in paragraph b for an applicant with an IRSN or ITIN.

    If Then
    A) the applicant or an authorized third party signed Form 13441-A process Form 13441-A following processing procedures
    B) neither the applicant nor an authorized third party signed Form 13441-A
    • Don’t enter Form 13441-A into database

    • Request signature with Letter 4541

    • Return Form 13341-A and all supporting documents to the applicant with Letter 4541.

    • In letter 4541 check the “Missing Signature” box

    • Review Form 13441-A for other missing or inconsistent items and request those too.

    • Set the status of the application to Enrollment determination application to "Enrollment determination Application Processing - Waiting for supporting Documentation" .

    C) the applicant’s TIN is an ITIN or IRSN
    • Don’t enter Form 13441-A into the database.

    • Send letter 4540 to the taxpayer

    • Choose the paragraph Unqualified Health Insurance Coverage

    • Return Form 13441-A and all supporting documentation to the applicant

  11. Remittance discovered in an application packet or in correspondence that’s connected to or mentions the HCTC.

    1. Photocopy Form 13441-A if it’s present.

    2. Forward the remittance

    If And Then
    A) the remittance is payable to US Treasury - HCTC send correspondence and he remittance, along with any photocopied Form 13441-A, to:
    US Treasury
    HCTC PO Box 970023
    St. Louis, MO 63197-0023
    B) the remittance isn’t payable to US Treasury - HCTC the remittance is written out for the IRS, the Federal Reserve or a vendor determine the intention of the payment from the documents in the application packet or applicant’s correspondence
    Send any remittance intended for the HCTC, along with the correspondence and any photocopied Form 13441-A to:
    US Treasury - HCTC
    PO Box 970023
    St. Louis MO 63197 - 0023
    C) the remittance isn’t payable to US Treasury - HCTC you can’t determine the intentions of the payment from the documents in the application packet or the correspondence or you determine that the payment isn’t for HCTC follow local procedures for discovered remittance
  12. Before entering Form 13441-A into the database verify it is batched correctly. If the form is in the wrong batch remove the form from the batch and follow local procedures for forms to be rebatched. Before entering Form 13441-A into the database search for an application from the applicant already in the database.

    1. Go to the Enrollment Search

    2. In the drop-down menu on the left side of the page choose Social Security Number, Participant Identification Number, or Name (Last, First). Enter the relevant information in the box to the right of the drop-down item. Check any results against the Form 13441-A.

    If And Then
    A) the applicant isn’t in the database create a new record with the information in Form 13441-A
    B) the applicant is already in the database the documents in hand are a response to correspondence and the status of the application is "Waiting for supporting documentation"
    • enter the requested items into the database

    • change any information in the database the applicant changed in the response

    C) the applicant is already in the database the documents in hand are a response to correspondence and the status of the application is Participant Enrollment Determination Ineligible: "Participant not eligible" refer the response to a clerk for association with the original application and rebatching.
    D) the applicant is already in the database the document in hand is not a response to correspondence and doesn’t change the information in the database consider the Form 13441-A a duplicate and associate it with the first Form 13441-A
    E) the applicant is already in the database the document in had is not a response to correspondence but changes information in the database and the status of the application isn’t "declined" ," ineligible" , or "enrolled" .
    • revise the affected information in the database and modify the applicant’s status in keeping with the new information.

    • Associate the response with the original application

    • Consider the submission a superseding or supplementary Form 13441-A

Creating a New Record from Form 13441-A

  1. Form 13441-A is made up of six parts. The examiners enter the information from each part into the HCTC database.

    1. Part 1, Your general information

    2. Part 2, Confirm your eligibility

    3. Part 3, Family Member Information

    4. Part 4, Health Plan Information

    5. Part 5, Account Accessibility

    6. Part 6, Form completion

  2. Enter the information the taxpayer provides with Form 13441-A into the database. Some information may be imperfect or missing. The instructions will let you know when you must suspend processing because of missing or defective information. Otherwise enter all information in Form 13441-A into the database.

  3. Procedures for items in Form 13441-A include instructions for correspondence. Correspondence occurs for the most part only after you’ve entered all the information in Form 13441-A into the database. The correspondence must treat all deficiencies in the form.

  4. A Form 13441-A with no signature or a signature not between the jurat and the notice for the Privacy Act and Paperwork Reduction Act is unacceptable and will be returned to the applicant. Procedures for the missing or unacceptable signature appear in IRM 3.11.29.4.3.

  5. If any required information—except for the signature—is missing, invalid, or illegible continue creating the record. Required items are noted in the procedures for each part of Form 13441-A. Edit, in erasable red ink on Form 13441-A, any required information you perfect.

  6. If any non-required information is missing, such as the Zip Code, and you discover it in a coincidental activity enter it into the database. Editing perfected non-required information on Form 13441-A is optional.

  7. If you must delete a record refer the application to your lead examiner. The lead examiner reports all deletions in a spreadsheet and sends the spreadsheet to IT.

General Information, Part 1 of Form 13441-A

  1. At Enrollment Search in the database click on the button New Enrollment. General Information appears. Enter the information in Part 1 of Form 13441-A into the relevant fields. Use Tab to move from field to field. Don’t enter hyphens or parentheses. The database adds that formatting.

  2. Fields for information in Part 1, "General Information," of Form 13441-A appear in the table below.

    Items Format Length Required
    First Name alphanumeric 25 Yes
    Middle Name alphanumeric 25 No
    Last Name alphanumeric 35 Yes
    Suffix alphanumeric 10 no
    SSN numeric 9 Yes
    Primary Phone number numeric 10 No
    Alternative Phone number numeric 10 No
    Mailing address line 1 alphanumeric 55 Yes
    Mailing address line 2 alphanumeric 55 No
    City alpha 30 Yes
    Zip Code numeric 15 No

    Note:

    Don’t abbreviate names. If a name is longer than its field just type it as written until you reach the end of the field. An applicant with an ITIN or IRSN is not eligible for HCTC.

  3. If any required information is missing, invalid, or illegible continue creating the record. Required items are noted in the last column of the table above. Edit, in erasable red ink on Form 13441-A, any required information you perfect.

  4. If any non-required information is missing, such as the zip code and you discover it in the review of Form 13441-A, enter it into the database. Editing perfected non-required information on Form 13441-A is optional. Use CC NAMES to perfect the address.

  5. Enter original IRS Received Date. If an update is received the original received date should be honored.

  6. After you enter the applicant’s SSN into the database an eligibility indicator appears.

    1. If the message "individual is eligible" appears the applicant is eligible for participation in the HCTC. Proceed with creating the record in the database.

    2. If the message "individual is eligible" doesn’t appear and no letter of eligibility is present verify the SSN with command code INOLE.

    • If the SSN in Form 13441-A doesn’t belong to the applicant search for the valid SSN with CC NAMES or search for a different, valid SSN in the supporting documents.

    • Verify with INOLE the validity of the SSN found in the supporting documents before entering it into the database.

    • If the applicant entered the wrong SSN in Form 13441-A replace the incorrect SSN in the database with the valid SSN retrieved with NAMES or from the supporting documents. Write the correct SSN in the margin to the left of the box for the SSN.

    • Proceed with creating the record in the database.

  7. If the message "individual is eligible" doesn’t appear and the applicant’s SSN in Form 13441-A is invalid and you can’t locate the applicant’s valid SSN

    1. Check to see if this is a Qualified Family Member participant (QFMP). Refer to IRM 3.11.29.4.5.3

    2. Correspond with letter 4541

    3. Check the box Incomplete Registration Form and just below it, Part 1 Your General Information

    4. Set the status of the application to "Enrollment determination Application Processing—Waiting for Supporting Documentation."

  8. If the message "individual is eligible" doesn’t appear and the applicant’s SSN is valid, the applicant may be eligible nonetheless. Search for a letter of eligibility from the DoL or PBGC or a Form 1099-R issued for the PBGC. Refer to IRM 3.11.29- 4 for documents that establish the applicant’s eligibility. If a letter of eligibility or relevant Form 1099-R is present, consider the applicant eligible and proceed with processing Form 13441-A.

  9. If no letter of eligibility or relevant Form 1099-R is present, follow the instructions below according to the applicant’s group. Note the different procedures by processing date for the DoL. Refer to IRM 3.11.29-4 for documents that establish the applicant’s eligibility. These instructions appear in IRM 3.11.29.6 too.

  10. PBGC and applicant not over 64 year old, no letter of eligibility or Form 1099-R issued for the PBGC in the application packet.

    • Decline the application, send letter 4540

    • Choose the paragraph "Participant eligibility"

    • Set the status of the application to "Missing Documentation" .

  11. PBGC and applicant over 64 years old, no letter of eligibility or Form 1099-R issued for the PBGC in the application packet

    • Decline the application, send letter 4540

    • Choose the open paragraph. Paste in the text for he applicant who belongs to the PBGC and is over 64 years old.

    • Choose the paragraph "Participant eligibility"

    • Set the status of the application to "Missing Documentation"

  12. DoL (TRA, RTAA, or ATTA), before January 1, 2017 . Records from the DoL won’t have been loaded. .

    • No letter of eligibility from the DoL in the application packet

    • Decline the application, send letter 4540

    • Choose the paragraph "Participant eligibility"

    • Set the status of the application to "Missing Documentation"

  13. DoL (TRA, RTAA, or ATTA) January 1, 2017, and later

    • No letter of eligibility from the DoL in the application packet

    • Decline the application, send letter 4540

    • Choose the paragraph "Participant eligibility"

    • Set the status of the application to "Missing Documentation"

  14. Correspond for correction or completion of required information after you’ve finished creating the record. Use the table below to determine which letter to use and which status to set.

    If... And... Then
    in Part 1 of Form 13441-A any required information is missing incomplete or illegible the required information can’t be perfected with other information provided by the applicant or with research in IDRS
    1. Correspond with letter 4541. Check the box incomplete registration form and, just below it "Part 1, Your General information"

    2. Set the status to the application to Enrollment determination Application Processing - Waiting for supporting documentation

    Note:

    Use the envelope and attachments to perfect a defective address. Don’t replace the address in the Form 13441-A with the address on the envelope or in any attachment. Use the address on the envelope or in an attachment only to perfect elements of the address for example the house number, street name, apartment number or zip code.

  15. Tab to the button Continue and tap the space bar to go to Eligibility, Part 2 of Form 13441-A

Eligibility Confirmation, Part 2 of Form 13441-A

  1. Click on the bar Eligibility Confirmation, below the zip code, to expand the section. At the top of the screen the tab Eligibility is brought forward and enlarged and its icon is in color.

  2. Enter the information in Part 2 of Form 13441-A into the relevant fields of the database. Use Tab to move from field to field.

    Item Entry
    Question 1:
    • PBGC or

    • TAA, ATAA, or RTAA

    • Tab to the circle that corresponds to the applicant’s entry and press the space bar

    Question 2:
    • Certification of general requirements

    • Tab to the box and press the space bar if the applicant checks the box.

  3. If any required information except for the signature is miss, invalid or illegible continue creating the record.

  4. Correspond for correction or completion of information after you’ve finished creating the record. A response to both questions is required.

    If And Then
    A) in Part 2 of Form 13441-A Question 1, the applicant checks both boxes or no o for group eligibility:
    • PBGC

    • TAA, ATAA, or RTAA

    1. a copy is present of
    • the official letter from the PBGC stating that the applicant received a benefit paid by the PBGC or

    • a Form 1099-R showing a benefit paid by the PBGC

    tab to the button PBGC and press the space bar
    2. a copy is present of
    • the official letter from the Department of Labor states that the applicant is eligible for the trade adjustment benefits or

    • a letter from a state workforce agency (SWA) or employment office states that the applicant is eligible for trade adjustments benefit

    tab to the button TAA, ATAA or RTAA and press the spacebar
    3. you cannot determine which group the applicant belongs to
    • Correspond with letter 4541. Check the box "Incomplete Registration Form" and, just below it Part 2, Confirmation of Eligibility,

    • Set the status of the application to" Enrollment determination Application Processing - Waiting for Supporting Documentation"

    B) in Part 2 of Form 13441-A
    • Question 2 the applicant doesn’t check the box for certification that she meets all general requirements

    • Correspond with letter 4541. Check the box "Incomplete Registration Form and just below it. Part 2, Confirmation of Eligibility."

    • Set the status of the application to" Enrollment determination Application Processing - Waiting for supporting Documentation."

  5. Tab to the button Continue and tap the space bar to go to Family, Part 3 of Form 13441-A.

Family Member Information, Part 3 of Form 13441-A

  1. At the top of the section the tab Family is brought forward and enlarged and its icon is in color.

  2. The applicant reports in Part 3 whether other family members are being registered for the HCTC. The applicant doesn’t include herself in his section.

  3. In the space beside the instruction "Please list the total number of family members the applicant writes the number of family members" besides herself who are being registered.

  4. Applicants who report no family members leave the space blank or may write 0 (zero) and don’t check the box below the number of family members in certification of eligibility.

  5. Applicants who register family members enter in the space beside the instruction "Please list the total number of family members" .

No Family Members

  1. The applicant reports no family members.

    If the applicant And Then
    A) leaves the space for the number of family members blank or enters 0 (zero) there 1. doesn’t check the box for certification below he number of family members and no family members appear in Part 3 and in line 1 of Part 4 of Form 13441-A tab to the button "No" and press the space bar and proceed to Part 4.
    2. checks the box for certification below te number of family members and no family members appear in Part 3 or in line 1 in Part 4 of Form 13441-A tab to the button "No" and press the space bar and proceed to Part 4
    3. doesn’t check the box for certification below the number of family members but family members appear in line 1 in Part 4 of Form 13441-A
    • tab to the button "No" and press the space bar and proceed to Part 4.

    • Correspond with letter 4541. Check the box "Incomplete Registration Form" and just below it Part 3, Family Member Information.

    • Set the status o he application to Enrollment determination Application Processing - Waiting for supporting Documentation.

    B) enters the number 1 (one) in the space for the number of family members doesn’t check the box for certification below the number of family members appear in Part 3 and in line 1 in Part 4 of Form 13441-A. tab to the button "No" and press the space bar and proceed to Part 4
    C) enters the number 1 (one) in the space for the number of family members 1. doesn’t check the box for certification below the number of family members appear in Part 3 and in line 1 in Part 4 of Form 13441-A tab to the button No and press the space bar and proceed to Part 4
    2. checks the box for certification below the number of family members and no family members appear in Part 3 and in line 1 in Part 4 of Form 13441-A tab to the button No and press the space bar and proceed to Part 4
    D) enters a number greater than 1 (one) in the space for the numbers but enters no information for family member in Part 3 family members appear in line 1 in Part 4 of Form 13441-A
    • tab to the button No and press the space band and proceed to Part 4

    • correspond with letter 4541. Check the box "Incomplete Registration Form" and just blow it Part 3, Family Member Information

    • Set the status of the application to" Enrollment determination Application Processing - Waiting for Supporting Documentation" .

    Note:

    Family members are included in the number of registrants on line 1 in Part 4 of Form 13441-A. A number greater than 1 one there indicates that the applicant has included family members.

  2. Tab to the button continue and tap the space bar to go to Health Plan, Part 4 of Form 13441-A

Family Members

  1. The applicant reports here whether other family members are being registered for the HCTC. The applicant doesn’t include herself in this section.

  2. Applicants who reply with No must provide a separate Part 4 of Form 13441-A with family members plan information, is this person on your health plan "No"

    1. Enter Part 4 info for Qualified Family Member, form page 3 of Form 13441-A as a separate record

    2. Pull page 3 of Form 13441-A and edit PIN on the upper right hand corner

    3. Create 4545 letter and staple to back f the Family Member’s page 3

    4. Edit action trail on HCTC Eligible Recipient’s original Form 13441-A

    5. Detached Family Member’s page 3 PIN 000000000

  3. Applicants who register family members enter in the space beside the instruction "Please list the total number of family members..." the number of family members number of family members being registered in addition to herself. These applicants check the box below the number of family members in certification eligibility. If the applicant registers ore than three family members she submits a copy of Part 3 for additional family members.

  4. The applicant who reports family members provides the information in the table. Enter into the database the information in the table below:

    Item Required
    1. Family member’s name: first and last yes
    2. Family member’s SSN

    Note:

    If TIN displays as invalid, then verify the validity of the family members SSN with INOLE. ATINs and ITINs do not affect HCTC eligibility and are acceptable.

    yes
    3. Family member’s date of birth no
    4. Family member’s relationship to applicant no
    5. Family member on health plan: Yes or No

    Note:

    Applicants who reply with No have to provide a separate Part 4 of Form 13441-A with the family member’s plan information.

    yes
  5. The instructions in the table below apply to each family member.

    If the applicant And Then
    A) provides defective information or omits information 1) supporting documents are present perfect missing or defective information with relevant information found in the supporting documents. Don’t correspond for missing information about family members.
    2) supporting documents not present perfect information with other relevant information available in the application Don’t correspond for missing information about family members.
    B) doesn’t check the box in certification of eligibility 1) does provide all the required information as described in the table in paragraph 3 enter the information available for the family members and proceed to Part 4
    2) does not provide all the required information as described in the table in paragraph 3 enter any information for the family members and proceed to Part 4.
    • Correspond with letter 4541. Check the box "Incomplete Registration Form and just below it Part 3, Family Member Information"

    • Set the status of the application to "Enrollment determination Application Processing - Waiting for Supporting Documentation"

  6. Tab to the button Continue and tap the space bar to go to Health Plan, Part 4 of Fom 13441-A.

Qualified Family Member Participant (QFMP) under Certain Provisions

  1. This section outlines processing a QFMP enrollment form and the difference between a Qualified Family Member (QFM) included on an enrollment form and a QFMP that is eligible on their own due to the legislative provision of QFMP under Certain Life Events. Legislation allows for the continuation of HCTC benefits for QFMPs after the primary eligible individual has enrolled in Medicare, or has passed away. This provision also allows the QFMP to continue to receive HCTC benefits once they have been divorced from the primary participant. A QFMP must also meet the same general requirements as a primary participant. In the event a primary participant enrolls in Medicare, passes away, or is divorced from his or her spouse, QFMPs can receive the HCTC for up to 24 months from the date of these events, (for example, date of enrollment in Medicare, death or finalized divorce decree. Example: If a primary participant dies, divorces, or enrolls in Medicare on January 12, 2016, the QFMP can only receive the HCTC until January 12, 2018, regardless of when they enroll in the AMP). Form 13441-A HCTC Registration and Update Form must be completed, signed and processed in accordance to IRM 3.11.29.2. Box 5 of Form 13441-A HCTC Registration and Update form should be checked. However, a review of the form could also determine that the form is for a QFMP and will be processed as such, even if the box is not checked. In addition to 3.11.29.2 a QFMP enrollment form requires the additional processing.

  2. Provision: QFMP Medicare Enrollment

    • The enrollment form will be accepted if either the PBGC payee or TAA recipient enrolled in Medicare or the QFMP general information in Part I is completed and signed by either taxpayer.

    • A Medicare enrollment letter, or documentation showing the PBGC payee or TAA recipient is enrolled in Medicare, is required and must include a Medicare effective date.

  3. Provision: QFMP Death Enrollment

    • The QFMP Death enrollment form must be completed and signed by the QFMP and will be enrolled in their name.

    • A death certificate, or similar documentation, is required for the PBGC payee or TAA recipient that includes the date of death.

  4. Provision QFMP Divorce Enrollment

    • The QFMP Divorce enrollment form must be completed and signed by the QFMP and will be enrolled in their name.

    • A divorce certificate, or similar documentation, is required for the PBGC payee or TAA recipient and must include the date of divorce.

  5. Once a QFMP is enrolled, the HCTC Enrollment Team Coordinator will conduct a monthly review of QFMPs. With this review, once it is determined the two year, 24 month eligibility has expired and move the case from enrolled into permanently ineligible and issue Letter 4540 notifying them they are no longer eligible for the HCTC.

Health Plan Information, Part 4 of Form 13441-A

  1. If any required information is missing from Part 4, Health Plan Information, of Form 13441-A and there are no procedures for it in the table in paragraph 4

    1. correspond for it with letter 4541 and

    2. check the box" Incomplete Registration Form" and, just below it, "Part 4, Health Plan Information" and

    3. set the status of the application to "Enrollment determination Application Processing—Waiting for Supporting Documentation" .

  2. At the top of the screen the tab Health Plan is brought forward and enlarged and its icon is in color.

  3. The applicant reports I Part 4 of Form 13441-A information about the health plan for herself and the family members. The applicant reports information about family members with a separate plan with a separate Par 4.

    1. Enter the information in Part 4 of Form 13441-A into the relevant fields of the database. Use Tab to move from field to field

    2. In general applicants must provide any item marked required.

    3. Transcription of an item is required if the applicant provides it.

    4. The items marked not required in the table below may legitimately be absent from Form 13441-A.

    5. If unable to locate the HPA Vendor Number or if it is unclear what the HPA Vendor should be, take Form 13441-A to HCTC Coordinator. The HCTC Coordinator will perform additional research, including making calls to TPAs/HPAs and pulling Form 3881s. If still unable to determine HPA Vendor, research will be elevated to P&A for resolution. Correspondence will only be initiated, if all research is exhausted.”

    6. The applicant doesn’t provide the vendor number of the Health Plan Administrator (HPA). The examiner retrieves the vendor number from a list of registered HPAs.

    7. Exceptions to bullet a are described in paragraph 4.

      Note:

      Vendors must recertify as a approved HCTC vendor yearly.

    Item Required
    1. Name of health plan provider yes
    2. Effective date of coverage: MMDDYYYY yes
    3. Vendor number
    • Locate the vendor number in the list of vendor numbers in the folder Approved HCTC Vendor List at the SharePoint.

    • Copy the vendor number in the list and paste the number into the field HPA Vendor Number

    • The list of vendors at SharePoint is updated the 15th and 30th of each month

    yes
    4. ID number of health plan no
    5. At least one of these:
    • Member ID or

    • Group ID or

    • Policy or Plan ID

    yes
    6. First name of policyholder yes
    7. Middle initial of policyholder no
    8. Last name of policyholder yes
    9. Suffix of policyholder’s name no
    10. policyholder’s SSN yes
    11. Total monthly premium yes
    12. Total number of people covered by policy: line 1 no
    13. Number of family members not qualified for HCTC: line 2 no
    14. Other health benefits line 4 no
    15. COBRA: former employer no
    16. COBRA: former employer’s HR phone number no
    17. COBRA: start date of coverage no
    18. COBRA: end date of coverage no
    19. COBRA: lifetime benefit no
  4. Before corresponding for any missing or defective required information in Part 4, Health Plan Information, of Form 13441-A look through the attachments and Form 13441-A for it. If you can’t locate the required information follow the instructions in the table below or in paragraph 5.

    If And Then
    A) you can’t find the vendor number in the list at the SharePoint you can’t locate the vendor number in the supporting documents or a vendor number you locate in the supporting documents differs from the vendor number in the list at share point
    1. Correspond with letter 4540

    2. Chose the paragraph Unable to verify Health Plan Administrator (HPA) set up

    3. Choose the open paragraph and paste in the approved text for any defective items in the packet

    B) the policyholder is the applicant the policyholder’s SSN differs from the SSN in Part 1 of Form 13441-A replace the SSN in Part 4 with the valid SSN in Part 1
    1. If the SSN in Part 1 is invalid and you couldn’t correct it, don't process Form 13441-A.

    2. Follow the instructions for invalid or missing SSNs

    C) the policyholder is the applicant
    1. the policyholder’s SSN is missing or defective and the valid SSN couldn’t be located through IDRS research

    2. the applicant’s SSN in Part 1 is invalid

    1. don’t process Form 13441-A

    2. correspond with letter 4541

    3. check the box "Incomplete Registration Form and Part 4, Health Plan Information" .

    4. set the status of the application to "Processing waiting for supporting documents"

    D) the policyholder is the applicant the policyholder’s SSN is missing or defective and you can’t correct it with in the information in the applicant’s Form 13441-A or supporting documents.
    • An SSN is defective when it has fewer than more than nine digits

    • it’s made up of a single digit: 111-11-1111 or repeating digits: 111-22-3333 for instance

    1. If you find an SSN for the family member write itin the margin to the left of the box for the family member and enter it in the database.

    2. if you don’t have an SSN for the family member request it and continue through Part 4

    3. correspond with letter 4541.

    4. check the box "Incomplete Registration Form in Part 4 Health Plan information"

    5. Set the status of the application to "Processing waiting for supporting documentation"

    E) line 1, Total number of people is blank no family members are present in Part 3 and no attachments for family members are present enter 1 in the field "Total number of people on policy"
    F) line 1, Total number of people is blank at least one family member is present in Part 3 enter in the field "Total number of people on policy" the sum of the applicant plus the family members in Part 3
    G) line 2 Number of family members not qualified for the HCTC, has an entry greater than zero line 2, Monthly premium for family members not qualified is blank or zero enter the applicant’s figure on line 2 into the field
    H) line 3, "Monthly premium for family members not qualified" , has an entry greater than zero line 3 Number of family members not qualified for he HCTC is blank or zero perfect the applicant’s entry on line 3 with information in the supporting documents and enter the perfected figure into the database
    I) any part of the section for COBRA has an entry enter any information the applicant provides into the database
  5. If any required information is missing from Part 4, Health Plan Information, of Form 13441-A and there are no procedures for it in the table in paragraph 4

    1. correspond for it with letter 4541 and

    2. check the box "Incomplete Registration Form" and, just below it, Part 4, Health Plan Information and

    3. set the status of the application to Processing—"Waiting for Supporting Documentation" .

Account Accessibility, Part 5 of Form 13441-A

  1. In Part 5 the applicant nominates a representative—a third-party designee—who may have access to information about her account. The third-party designee may inquire into or change the registrant’s HCTC account or personal information.

  2. The applicant who chooses not to nominate a third-party designee may leave all of Part 5 blank or check the box No and leave the rest of Part 5 blank.

  3. The applicant who nominates a third-party designee checks the box Yes and completes the rest of Part 5.

  4. Enter the information in Part 4 of Form 13441-A into the relevant fields of the database. Use Tab to move from field to field.

  5. If the applicant doesn’t nominate a third-party designee tab to the button No at Account Accessibility and press the space bar. Tab to the button Continue and press the space bar. The database will take you to Summary. No correspondence is necessary if any or all of the information is missing or incomplete.

  6. If the applicant nominates a third-party designee tab to the button Yes at Account Accessibility and press the space bar. Tab on the button Continue and press the space bar. In the next screen enter the information about the third-party designee.

  7. Enter the information in Part 5 of Form 13441-A into the relevant fields of the database. Use Tab to move from field to field.

    Item Required
    Name of third party designee; first and last no
    Primary telephone number no
    Alternate telephone number no
    PIN no
  8. The instructions below apply to inconsistencies or omissions in the information for the third-party designee.

    If And Then
    the applicant checks the box Yes the applicant provides a name and a valid PIN but doesn’t provide any phone number

    Note:

    To be a valid, PIN must be made up of numbers only and be five digits long.

    transcribe the information and proceed to Part 6
    the applicant provides a name but the applicant doesn’t provide a valid PIN

    Note:

    To be valid a PIN must be made up of numbers only and be five digits long.

    transcribe the information, except for the invalid PIN and proceed to Part 6
    the applicant checks the box No the applicant writes in a name or PIN for a third party designee transcribe the name and valid PIN

Form Completion, Part 6 of Form 13441-A

  1. In Part 6 the applicant signs Form 13441-A.

  2. Don’t process Form 13441-A without a signature.

  3. Return the unsigned Form 13441-A and all related documents to the applicant. Refer to instructions for the unsigned Form 13441-A in IRM 3.11.29.23(2)d.

    1. Send letter 4541

    2. Check the box missing signature

  4. If you’ve entered Form 13441-A into the database delete the record. Instructions for the unsigned Form 13441-A appear in IRM 3.11.29.23(2)d

  5. Refer the packet to the lead examiner or other designated person

Review Supporting Documents

  1. Applicants must submit a copy of a bill for health insurance dated within the last sixty days together with Form 13441-A.

    Note:

    Applicants who have changed their insurance within the last sixty days or acquired insurance within the last sixty days won’t have a bill or may not have to provide one. They may submit a statement from their Health Plan Administrator (HPA) that they have qualified coverage and are eligible for the HCTC. See IRM 3.11.29.16(3) for instructions.

  2. The bill must provide the information in the list below. If any of the items in the list is missing, correspond for it using letter 4541. Check the box Required Supporting Documents. Set the status of the application to Enrollment determination processing - waiting for supporting documentation. Otherwise, unless it meets the conditions described in the Note above, it is an inadequate document.

    • the name of the applicant

    • the dates of coverage

    • the amount of the monthly premium

    • the name of the Health Plan Administrator (HPA)

  3. Exceptions to the requirement for a bill

    1. Some applicants who belong to the Delphi Salaried Retirees Association Benefit Trust (DSRA-BT) may submit a letter or notice of qualified insurance in place of a bill.

    2. The applicant submits a bill from 2016. Determine whether the applicant’s bill from 2016 is adequate for 2017.

    If And Then
    the applicant changed insurance within the last sixty days or acquired insurance within the last sixty days
    • the applicant has an invoice for an insurance plan for September, October, or November 2016 and

    • the rate for 2016 and 2017 is the same and the res of the plan remains unchanged too for January 2017

    accept the bill as proof of insurance
    • the applicant has an invoice for an insurance plan for September, October or November 2016 and the rate for 2016 and 2017 is different

    don’t accept the bill as proof of insurance
    • correspond with letter 4541. "Check the box Required Supporting Documents" .

    • Set the status of the application to "Enrollment determination Application Processing -Waiting for Supporting Documentation."

  4. The applicant doesn’t submit a bill. Determine whether the applicant is required to submit a bill or submit a leter or notice in place of a bill.

    If the applicant And the applicant Then
    the applicant changed insurance within the last sixty days or acquired insurance within the last days
    • participates in the interim program or 2016 and doesn’t change her plan or the persons covered in the plan for 2017

    the bill isn’t required
    • participates in the interim program or 2016 and

    • changes her plan for 2017

    • the applicant must provide a letter or notice from her new insurance provider

    • That letter or notice must state that the applicant has been enrolled and provide the effective date of coverage

    is new to the HCTC for 2017
    • the applicant must provide a letter or notice from her new insurance provider.

    • that letter or notice must state that the applicant has been enrolled and provide the effective date of coverage.

Determining the Eligibility of the Applicant

  1. To determine the applicant’s eligibility for the HCTC, the database checks the record created from Form 13441-A against information from the DoL and PBGC. If the DoL or PBGC haven’t sent the IRS notice of the applicant’s eligibility, the database displays a message, in red, that the applicant’s not eligible for the HCTC

  2. If the database returns the message that the applicant’s eligible and the application is for a new enrollment

    1. Send the applicant letter 4545. Note the amount and the due date of the payment in the field for each in letter 4545.

    2. The amount of the payment is the monthly HCTC payment.

    3. The due date is the 10th of the month after the month Form 13441-A is processed and marked completed.

  3. If the database returns the message that the applicant’s eligible and the application is for a updated registration

    1. Search in the database for an earlier application from the applicant.

    2. Go to Enrollment Search.

    3. In the drop-down menu on the left side of the page choose Social Security Number, Participant Identification Number, or Name (last, first).

    4. Enter the applicant’s information into the field to the right of the item you chose.

    5. Modify the information in the database according to the information in Form 13441-A.

    6. Send the applicant letter 4545. Note the updated amount and the due date of the payment in the field for each in letter 4545.

    7. The updated amount of the payment is the monthly HCTC payment.

    8. The due date is the 10th of the month after the month Form 13441-A is processed and marked completed

  4. If the database returns the message that the applicant’s ineligible for the HCTC, but the applicant provides a letter of eligibility from the DoL or PBGC or a Form 1099-R issued for the PBGC consider the applicant eligible for the HCTC and process the application.

  5. If the database returns the message that the applicant’s ineligible for the HCTC and the applicant doesn’t provide a letter of eligibility from the DoL or PBGC or a Form1099-R issued for the PBGC follow the instructions below according to the applicant’s group. Note the different procedures by age for the PBGC and by date for the DoL.

  6. PBGC: applicant not over 64 years old

    • Decline the application.

    • Send letter 4540. Choose the paragraph "Participant eligibility"

    • Set the status of the application to "Missing Documentation" .

  7. PBGC: applicant over 64 years old

    • Decline the application.

    • Send letter 4540.

    • Choose the open paragraph. Paste in the text for the applicant who belongs to the PBGC and is over 64 years old.

    • Choose the paragraph "Participant eligibility"

    • Set the status of the application to "Missing Documentation"

  8. DoL (TRA, RTAA, or ATTA), before January 1, 2017

    • Records from the DoL won’t have been loaded and the applicant will appear to be ineligible.

    • Look for a letter of eligibility letter from the DoL in the applicant’s packet.

    • If you find a letter of eligibility from the DoL, consider the applicant eligible.

    • If you don’t find a letter of eligibility from the DoL, send letter 4540. Choose the paragraph "Participant eligibility."

    • Set the status of the application to "Missing Documentation" .

Verifying Eligibility and Payments

  1. Verify the information is transcribed accurately. The Lockbox site will key-verify transcribed fields.

  2. U.S. Bank Lock box site will follow instructions and request payments from the enrollment payment team

  3. If the PIN is contained in the RPF (field 6) and the remittance amount matches the amount due (Field 7 plus Field 9), the Lockbox site will process the remittance.

  4. If no payment coupon is enclosed with the remittance, process the remittance using the PIN noted on the remittance or other correspondence.

  5. If no PIN is provided for a remittance or if the PIN is invalid, such as too many digits, fax the remittance and correspondence, by 12:00 pm CST, to the Austin HCTC Enrollment Team for research at the fax number below:

    • HCTC Coordinator

    • Austin HCTC Enrollment Team

    • ≡ ≡ ≡ ≡ ≡ ≡ ≡

  6. US Bank will contact HCTC Coordinator, for issues related to the fax (e.g. fax not going through). If HCTC Coordinator is not available, contact the HCTC Enrollment Team via email *wi.hctc.stakehldr.en@irs.gov. If no response received from Enrollment Team contact LPO employees:

    • ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡

    • ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡

  7. The Austin HCTC Enrollment Team will research the HCTC database for the missing/invalid PIN and provide a response to the Lockbox site by 10:00 am CST, the next business day, ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ .

  8. If the Austin HCTC Enrollment team supplies sufficient information for the missing/invalid PIN, the Lockbox site will process the remittance.

  9. If a valid PIN number is not contained in the RPF and cannot be located, reject back to the participant with all original contents and reject letter stating reason for return.

Lockbox Requirements

  1. HCTC participants are instructed to send their payments to a Lockbox depository for payment processing.

  2. If payment(s) received at the lockbox require additional information to process the payment (for example no PIN or too many numbers in the PIN), the lockbox will request the missing information from the Austin HCTC Enrollment team, via fax at 12:00pm CST daily.

  3. The Austin HCTC Enrollment team will research the HCTC database for missing/invalid PIN and provide a response to the lockbox by 10:00am CST the next business day.

  4. The lockbox site will return rejected payments back to the participant, via a reject letter. A copy of the reject letter and all contents that were mailed to the participant will be sent from the lockbox to the Austin HCTC Enrollment Team, via a Form 3210 as part of a daily mail out package. The Form 3210 must be signed by a representative of the Austin HCTC Enrollment Team and faxed to the lockbox facility to verify the contents were received.

  5. ) If the lockbox does not have a daily mail out package to send to the Austin HCTC Enrollment Team, they will issue an email to advise there is no mail out package.

  6. The lockbox site will prepare the following reports daily.

    • HCTC Payment Reject Report

    • HCTC Daily Production

Monthly Payment Reconciliation SF-1034

  1. Each month the Department of Treasury transmits 100% of the insurance premium payment to the HPA for all enrolled participants associated with the HPA’s vendor number. This payment file will be used to reconcile payment for each participant. It’s possible that the HPA/TPA may identify erroneous payments to the HPA’s vendor number such as "post-65" , an erroneous payment made to the HPA vendor number, an erroneous payment paid using the wrong PIN.

  2. Payment reconciliation will be handled on a case by case basis. The reconciliation process will be worked via conference calls with the TPA/HPA and emails sharing subsequent attestation spreadsheets.

  3. If a HPA/TPA contacts the Enrollment Team regarding a reconciliation issue, a representative from the Enrollment Team will contact Submission Processing HQ HCTC PMO. The SP HCTC PMO, will contact the HPA/TPA to determine resolution of the erroneous payments.

  4. Once the monthly reconciliation process is finalized, the HCTC PMO will send an email to the Austin Enrollment Team with specific instructions for processing the necessary SF-1034 to specific TPA/HPA/individual participants.

    Figure 3.11.29-1

    This is an Image: 69551061.gif

    Please click here for the text description of the image.

Finalized Payment Reconciliation Process

  1. Complete SF-1034 by inputting the following:

    • Input the voucher number:

    • TPA and MM-YYYY (M=Month Y=Year) Benistar January 2017

  2. Input payee’s name and address field:

    • Input vendor number for the TPA/HPA - Use the vender number per the approved vendor list

    • For 1034’s for individuals - always use vendor number 02020069

    • Input the PIN

    • Input the participant’s name

    • Input the participant’s address

  3. Articles or Services section: Input Payment/Reimbursement for MMYYYY HCTC AMP.

  4. The total amount and the approved for amount must match.

  5. Enter the appropriate Accounting Classification Codes provided by CFO. For the 72.5% appropriate account:

    • Fund: R0923HTC

    • Commitment: 41

    • Funds - Center RA04

    • Functional Area - RMAD

    • Order - CHTC

    • Bus. Area - 0002

  6. Enter the appropriate Accounting Classification Codes provided by CFO. For the 27.5% appropriate account:

    • Fund: R6163HTC

    • Commitment: 2400

    • Funds - Center: RA04

    • Functional Area: RMAD

    • Order: CHTC

    • Bus. Area: 0002

  7. Austin Submission Processing designed authorize certifying officers:

    1. Primary:
      Cornell "Tee" Turner, Operations Manager, DPO
      Kenneth Helsley, Department Manager, DPO

    2. Back-ups:
      Maureen Varnado, P&A Chief, SP
      Steve Marmon, P&A Manager, SP

  8. Create signature folder with the SF-1034 and the following attachments:

    • Action Routing Sheet

    • Copy of the spreadsheet with the list of HCTC participants and dollar amounts provided by the HCC PMO.

    • After the SF-1034 has been signed by the designated authorized official, email the SF-1034 to CFO to the following email address: CFOBFC.InvoicedLink@irs.gov.

    • A CFO representative will send a confirmation email to the Austin Enrollment Team via wi.hctc.stakehldr.en@irs.gov when the payment is sent to the TPA/HPA/individual. If a confirmation email is not received, contact Kathy Taylor, Leanna Lamb, or Nancy Taylor via email.

Setting the Status of the Application

  1. If an applicant is ineligible and the application or its support is defective the ineligibility takes priority. For ineligible applicants whose application is defective choose letter 4540 and set the status to "Participant Enrollment Determination Ineligible: Participant not eligible" . The procedures below offer further detail for processing.

  2. Original application or updated registration. The applicant’s eligible, but Information in Form 13441-A or the supporting documents is defective—missing, incomplete, invalid, or illegible.

    1. Set the status to "Enrollment determination Application Processing—Waiting for Supporting Documentation"

    2. Select letter 4541.

    3. Choose the relevant paragraph according to the deficiency in Form 13441-A or the supporting documents.

      Note:

      Check the box "Incomplete registration form" in addition to the box for a defect in part 1, 2, 3, 4, or 5 of Form 13441-A. The application may be defective for more than one reason. Select all the paragraphs necessary for describing all the defects.

  3. Original application or updated registration. The packet’s complete and acceptable, and the applicant’s eligible.

    1. Set the status of the record to Completed.

    2. Select letter 4545.

    3. Enter in erasable red ink the participant’s PIN to the right of" Participant ID number" .

    4. Enter the required payment in the field Amount due.

  4. Original application or updated registration. The packet’s incomplete or unacceptable, and the applicant’s eligible but didn’t reply to correspondence or didn’t reply adequately.

    1. Set the status of the record to "Participant Enrollment Determination Ineligible: Participant not eligible."

    2. Select letter 4540.

    3. Choose the paragraph" Incomplete registration form" or "Missing supporting documents" , according to the reason for the correspondence. If both reasons apply send both paragraphs

      Note:

      The application may be incomplete for more than one reason. Select all the paragraphs necessary for describing all the conditions of ineligibility.

  5. Original application or updated registration. The packet’s complete and acceptable, but the applicant’s ineligible.

    1. Set the status of the record to "Participant Enrollment Determination Ineligible: Participant not eligible"

    2. Select letter 4540

    3. Choose the paragraph that descries the condition of eligibility:
      Dependent
      Disqualifying health insurance coverage
      Imprisonment
      Spousal coverage
      Unqualified Health Insurance Coverage
      Participant eligibility

  6. Original application or updated registration. The packet’s incomplete or unacceptable, and the applicant’s ineligible.

    1. Set the status of the record to "Participant Enrollment Determination Ineligible: Participant not eligible" .

    2. Select letter 4540

    3. Choose the "paragraph Incomplete registration form" or Missing supporting documents" , according to the reason for the correspondence. If both reasons apply send both paragraphs.

    • Dependent

    • Disqualifying health insurance coverage

    • Imprisonment

    • Spousal coverage

    • Unqualified Health Insurance Coverage

    • Participant eligibility

Unprocessables/Rejects

  1. Unprocessable items will be returned to participants with a reject letter prepared by the Lockbox site, refer to, Payment Reject Letter, Exhibit 2.

  2. The Lockbox site must select the appropriate reject code on the letter for the returned items. The original payment coupon, remittance and correspondence must be mailed back to the participant.

  3. The Lockbox site employee(s) will create a reject letter with the participants address from the coupon or remittance. The letters must be counted and sent to U.S. Bank Operations Center Mail Room for postage and mailing.

  4. Ensure the participant correspondence received is copied and sent in the mail out package to the Austin HCTC Enrollment Team at the address listed below. Include a copy of the reject letter and all contents that were mailed to the participant.
    Internal Revenue Service
    AUSC Stop 6098
    3651 S Interstate 35
    Austin, Texas 78741

    Note:

    The site must ensure the PIN, if available, is written on the remittance or correspondence prior to sending to the Austin HCTC Enrollment Team.

  5. The Lockbox site must prepare a daily Payment Reject Report, Exhibit 7, this report must include the date, participant’s name control, participant’s PIN, and a reason the item was rejected (A-H) and a daily count of the rejected items. If the reject reason is "H" (other), the site must add comments to explain the reason the payment was rejected. If payment was rejected for an invalid or missing PIN (Reason Code D) and faxed to the Austin Enrollment Team, the site will enter the date and time of fax. This report will be provided to the following email addresses with HCTC Daily Reject Report _MMDDYYYY in the subject line of the email:
    irs.lockbox@irs.gov
    wi.hctc.stakehldr.en@irs.gov

  6. The Lockbox site must retain copies of rejected items on site for one year in retrievable format to support responses to government inquiries.

  7. This will include copies of the original reject letter, copies of the original payment coupon(s), remittance and correspondence. The reject letters will indicate reason for reject, date and PIN.

Mail Out Package

  1. The Lockbox site must use an approved dedicated overnight private delivery/freight service (e.g., FedEx, DHL, and UPS) to deliver shipments to the Austin HCTC Enrollment Team and the IRS Beckley Finance Center. The service provider must maintain custody of the shipment from the Lockbox site to the destination.

  2. The company must provide tracking of the shipment from the Lockbox site to the destination via electronic methods (e.g., email). The Lockbox site must ensure the LPO employees listed below are included on the tracking and monitor and confirm the shipments delivery:

    • ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡

    • ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡

  3. The Austin HCTC Enrollment Team package will include correspondence and envelopes received at the Lockbox site in which the site processed the participant remittance and items in Section 7.3, Unprocessables/Rejects. Correspondence includes an item received that is not a payment coupon or remittance.

  4. The Lockbox site must prepare a mail out package to the Austin HCTC Enrollment Team at the following address:
    Internal Revenue Service
    AUSC Stop 6098
    3651 S Interstate 35
    Austin, Texas 78741

    Note:

    On the occasion when no mail out package is required to be sent to the Austin Enrollment Team, a notification email must be sent to the following recipients:


    ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
    ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
    ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡

  5. The Lockbox site must also prepare a mail out package to the IRS Beckley Finance Center, which will include daily receipts of the Form 13560, HPA Return of Funds, refer to Section 7.1, Returned Overpayment Funds, and Section 7.2, Health Plan Administrator (HPA) Return of Funds. The site must include the payment, envelope or correspondence received with these items to the following address:
    Internal Revenue Service
    Beckley Finance Center
    110 N. Heber St.
    Beckley, WV 25801

  6. The Lockbox site will prepare Form 3210, Document Transmittal, identifying the package contents for all packages. The site must include the PIN and participant’s name control on the Form 3210.

  7. The Lockbox site will retain a completed copy of Form 3210 and will include two (2) copies of the completed Form 3210 (Recipient’s copy and Acknowledgement copy) with the shipment.

  8. Place the Form 3210 in an envelope, double-packaged and double-labeled, prior to shipping. Double packaging helps ensure the contents are protected if the outer package is damaged or destroyed during the shipping process. Duplicate shipping labels will allow the contents to be properly delivered without potential disclosure if the external package is damaged or destroyed.

  9. Place the double packaged and labeled envelope in a shipping package.

    Note:

    Shrink wrapping the external packaging or wrapping the external packaging in paper does not satisfy double packaging requirements

  10. External packaging material must not be marked or labeled with information indicating that the package contents include sensitive information. Seal the package with strong clear shipping tape that is two inches or more in width. Do not use string, paper over-wrap, shrink wrap or plastic straps.

  11. Place the shipping label on the top of the package and ensure it is properly adhered and will not separate from the box. Do not place the label over a seam or closure or on top of sealing tape since this could cause it to be damaged or removed from the package.

  12. Once the shipment is received, the recipient will verify the contents were received and sign the acknowledgment copy of the Form 3210. The Austin HCTC Enrollment team or the IRS Beckley Finance Center will return the signed, dated and acknowledged Form 3210, to the Lockbox site by 2:00 pm local time, using fax number ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡

  13. After receiving the acknowledgement copy, the Lockbox site will associate it with the original Form 3210.

  14. The Lockbox site will be responsible for monitoring the delivery of the shipment. The shipment(s) must be shipped in a manner that ensures they are received at the designated location by 12:00 pm local time the next business day following the day of the Lockbox deposit.

    Note:

    The tracking may indicate the shipment is delayed, if the site experiences a delayed shipment, refer to procedures in Section 14 Incident Reports.

Correspondence

  1. The enrollment team sends eight letters. These eight letters are catalog letters available in PDF at the Product Catalog.

    Letter Purpose
    3772 Participation Canceled
    4510 IRS HCTC Reimbursement Request- Denial
    4511 IRS HCTC Reimbursement Request -Insufficient Documentation
    4540 Notice of Ineligibility
    4541 Request for Missing Documents
    4545 Enrollment Confirmed
    5758 Receipt of Application
    5945 IRS HCTC Reimbursement Request - Eligible
    • Letter 3772. The enrollment team sends a participant letter 3772 when it cancels the participant’s registration in the HCTC.

    • Letter 4510. The enrollment team sends a participant letter 4510 when it denies the participant’s request for reimbursement.

    • Letter 4511. The enrollment team sends a participant letter 4511 when the participant provides insufficient documentation.

    • Letter 4540. The enrollment team sends an applicant letter 4540 when it determines that the applicant’s ineligible for the HCTC

    • Letter 4541. The enrollment team sends an applicant letter 4541 if Form 13441-A isn’t signed, the policyholder’s SSN is invalid, Form 13441-A is incomplete, or supporting documents are missing or incomplete.

    • Letter 4545. The enrollment team send the participant letter 4545 when the enrollment is confirmed

    • Letter 5758. At the discretion of management the enrollment team acknowledges receipt of Form 13441-A and supporting documents with letter 5758. Management must authorize the use of letter 5758. Do not send this letter without explicit instructions from management.

    • Letter 5945. The enrollment team sends the participant letter 5945 as proof of eligibility.

  2. If correspondence is required follow the steps below.

    1. If after review of Form 13441-A and documentation it is determined 2 separate letters would need to be mailed, you should use Letter 4540, using the fillable paragraph and sending only 1 letter.

    2. Open the template for the letter and enter the date and the applicant’s identification number—the final four digits of the SSN, in the format ***-**- NNNN— and fill in the fields in the letter with all required information.

    3. Include the Participant Identification Number (PIN) in the letter. Enter PIN on all correspondence. For letters 4540 and 4541, enter the PIN to the right of "Dear Candidate"

    4. Unless you return Form 13441-A because of a missing signature remove from the letter information concerning an enclosure. Letter 4540, page 2: remove the words Enclosure: Your HCTC registration form. Letter 4541, page 2: remove the words [Enclosure:] [Form 13441-A].

    5. Enter a description of the reason for the correspondence into AMS

    6. Print two copies of the letter. Staple one copy to the back of the packet. The other copy goes to the applicant.

    7. Fold the letter so that the address shows in the address window of the envelope.

    8. Stuff but doesn’t seal the envelope.

    9. Place the correspondence in the basket for review by PASS

    10. After PASS has reviewed the correspondence deliver the letters to the mail room for sealing and mailing.

  3. Place the applicant’s packet, with the copy of the letter, in the basket for suspense. Re-batch the packet under OFP 390-84333 and hold in the suspense inventory.

  4. All letters are subject to review by the Improvement Team. It will return incorrect letters to TEs for correction.

    Figure 3.11.29-2a

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    Figure 3.11.29-2b

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Record Retention Requirements

  1. The Lockbox site must capture an image of the front and back of all remittances and the payment posting documents (vouchers, facsimiles, remittance photocopies) for all transactions they process.

  2. The Lockbox site must retain electronically processed remittances for a period of five (5) business days after the ECP settlement date. These documents must be kept in a manner that is easily retrievable.

  3. The Lockbox site must retain paper vouchers or payment posting documents/facsimiles/photocopies for a period of five (5) business days after the ECP settlement date. These documents must be kept in a manner that is easily retrievable.

  4. Lockbox sites must retain ECP checks, paper vouchers or payment posting documents/facsimiles/photocopies in a locked/secured storage until the scheduled destruction.

  5. Prior to destruction, bank personnel must verify by fanning through each ECP batch to ensure no unprocessed checks are present. If a remittance is discovered, the site should contact IRS Lockbox Policy and Oversight.

  6. Following the five (5) day retention period, sites must destroy the processed remittances and voucher/payment posting documents at the next scheduled shredding

  7. RTR (Image) files must be retrievable for a period of 30 calendar days from creation. After the retention period expiration, the image files must be destroyed in accordance with the existing Media Protection Procedures, refer to LSG 2.6.12.

Daily Reports

  1. The Lockbox site will prepare the following daily reports and must retain copies on site for one year in retrievable format to support responses to government inquiries:

    1. Payment Reject Report, refer to Exhibit 7

    2. Daily Production Report, refer to Exhibit 11

      Note:

      email above reports daily to:


      irs.lockbox@irs.gov
      wi.hctc.stakehldr.en@irs.gov
      irslockboxreports@fms.treas.gov
      mailto:Blaire.Hamilton@fiscal.treasury.gov

    3. Mail Log refer to Section 3, Mail Pick-Up Schedule

    4. Mail out Log refer to Section 8, Mail out Package

    5. Discovered Remittance(s)/Correspondence Log, refer to Exhibit 3, as applicable. Scan and email this report monthly to:
      irs.lockbox@irs.gov

Weekly Statistical Report

  1. The HCTC Enrollment team lead or P&A analyst will provide a weekly statistical report on HCTC volumes.

  2. This report will be sent out every Monday morning.

Quality Review

  1. The appointed manager in Entity draws up a pull sheet by the week and sends it to the Quality Review (QR) manager and clerks.

  2. Tax examiners place their completed documents on designated carts and their folders into designated bins.

  3. Clerks from the QR unit, using the information on the pull sheet, retrieve the appropriate documents for sorting in the QR area.

  4. QR clerks deliver the documents to the reviewer.

  5. The reviewer opens the IRM 3.11.29 and checks for updates.

  6. The QR reviewer performs review at the measured rate of the tax examiners who process Form 13441-A.

  7. When all review is completed, create pink cards and make copies of the cards. Then return all documents to Entity.

  8. Place pink cards in the lead examiner’s inbox.

  9. Enter, from the copy of the pink cards, the results of the review into the Entity QR log.

  10. Dispose of copies of pink card that report no errors. Treat the cards as classified waste.

  11. Keep all pink cards that report an error. Attach all copies, with original, for future question or review.

  12. File the retained pink cards and the defect report every

  13. The quality reviewer must run a HCTC Enrollment database report daily to query any forms in complete status. If any records for forms are found to be three business days or older, the quality reviewer must change the status of the records from complete to enrolled.

Quality Review Check List

  1. Action: move record to Quality Review Status.

  2. Review Enrollment Form 13441-A and verify the following:

    1. Part 1: verify general information

    2. Part 2: confirm eligibility with the following guidelines
      Either the PBGC or TAA check box is checked
      The certification check box is checked

    3. Part 3: Family Member Information
      The certification check box is checked
      If total family members is provided, verify family member information provided

    4. Part 4: Health Plan Information
      Health Plan Provider, date of coverage and either Plan ID, Member ID, Group ID or Policy ID is provided
      Total monthly premium is provided
      Total Monthly HCTC payment matches Letter 4545
      COBRA information is provided, if applicable

    5. Part 6: Form completion
      Verify signature is in the signature box

  3. Correspondence to participants must be reviewed for accuracy. Review the following:

    • The correct letter is used

    • PIN is provided

    • Double check all taxpayer information (name, last 4 digits of social, address, PIN)

    • Confirm 27.5% amount on letter 4545 is correct

    • Verify enclosures are not included unless going out for signature

    • Copy of letter is stapled to the back of the form

    • Review of action trails for completeness

    • If anything above is incorrect send back to TE for correction

    • Once approved, move to enrolled status

Form 13441-A in Files

  1. Route Form 13441-A numbered with a PIN to Files at the Austin processing center. Files will hold the Form 13441-A until its retirement to the Federal Records Center (FRC).

  2. The packet with Form 13441-A is made up of one or more of the documents in the list below.

    1. The original Form 13441-A

    2. An updated Form 13441-A

    3. Required supporting documentation: a copy of the participant’s health insurance bill dated within the last 60-days.

    4. A copy of any correspondence sent to the applicant.

    5. Any correspondence sent by or on behalf of the applicant.

  3. Place two (2) Forms 3210 inside the box with the Forms 13441-A. Files AUSP signs one Form 3210 and returns the one it signs to AUSP Enrollment Team.

  4. Keep Form 13441-A in batches of 50 in order by Participant Identification Number (PIN) in a gusset folder. Write, with red ink, "HCTC" and year on the gusset folder. Also include volume on front.

  5. Include an Application Identification Sheet (AIS) and highlight the correct Participant Identification Number. The AIS is used to attach documents to the applicant’s packet.

  6. Use Form 2275, Records Request, Charge & Recharge, to retrieve Form 13441-A from Files. Mail Form 2275 to the Austin processing center or send it by e-fax or email.

  7. Retain Form 13441-A in Files at the Austin processing center for three (3) years. After the end of the third year retire Form 13441-A to the Federal Record Center (FRC) for an indefinite period.

  8. E-mail files Manager/Lead suspense spreadsheet weekly

  9. Refiles: Send forms (to be refiled) with a 3210 to Stop #6722 (Sort and Sequence). Be sure to include volume, release date and "HCTC" on the Form 3210

Form 4442

  1. If the form 4442 list a change of address use the chart below:

    If And Then
    Form 4442 transmits a change of address A) the status of the applicant’s record is Enrollment determination Application Processing -"Waiting for supporting documentation or Registration Application form received"
    1. change the record in accordance with the new address and

    2. send the original correspondence to the new address and

    3. allow 45 days for a reply to the new correspondence

    4. associate the response with the application

    B) the status of the applicant’s record isn’t Enrollment determination application processing - "Waiting for supporting documentation or Registration Application on Form received " associate the response with the application
  2. Return Form 4442 to originator if:

    1. the person named in Form 4442 isn’t in the database and the information attached to Form 4442 isn’t a Form 13441-A returned to the applicant because an earlier submission wasn’t signed or the SSN was invalid

    2. the Form 4442 doesn’t provide enough information for you to determine its relevance or intention or identify the applicant

    3. the Form 4442 was sent to the enrollment team in error.

  3. Form 4442 must be in date order and attached to the back of Form 13341-A.

Form 4442 Response to Correspondence

  1. Response to correspondence by the enrollment team

    If And Then
    Form 4442 transmits a reply to correspondence by the enrollment team the status of the applicant’s record is Enrollment determination Application Processing - Waiting for supporting documentations process Form 13441-A with the information in the applicant’s reply. Follow the procedures in IRM 3.11.29.6(5)
    the status of the applicant’s record isn’t Enrollment determination Application Processing - Waiting for Supporting Documentation Follow the procedures in IRM 3.11.29.6(5)

CONDITIONS OF ELIGIBILITY

Trade Adjustment Assistance (TAA)

  1. Individuals eligible under the TAA for the HCTC have lost their job because of international trade.

  2. Individuals certified eligible for TAA receive benefits through three programs.

  3. Trade Readjustment Allowance (TRA), a weekly cash payment for workers no longer eligible for unemployment benefits

  4. Reemployment Trade Adjustment Assistance (RTAA), a wage supplement for workers who are 50 or older and certified eligible under the terms of the TAA and find employment at a lower wage

  5. Alternative Trade Adjustment Assistance (ATTA), a wage insurance like the RTAA

  6. An individual is eligible for the HCTC on the first day of a month if the individual received a TAA benefit for any day in that month or the month before.

  7. Only individuals who receive cash benefits through the TRA, RTAA, or ATAA may be certified eligible for benefits under TAA. Individuals who receive non-cash benefits, such as assistance with looking for a job, aren’t eligible for the HCTC.

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THE database

Management provides the address of the database to examiners. Save the link to the desktop or make it a favorite.

Access the database:

  1. Request access to the database through the OL5081

  2. In the OL5081 go to Request New Application.

  3. Search for the application PROD USER HCTC.

  4. Select the role and group as your management instructs you.

  5. Submit the request for the application and role.

Role OL5081 App Name and Group
Clerk PROD USER HCTC CLERK DR USER HCTC CLERK
Examiner PROD USER HCTC TAX EXAMINER
Quality Reviewer PROD USER HCTC QUALITY REVIEWER DR USER HCTC QUALITY REVIEWER
HCTC PROD USER HCTC READ ONLY DR USER HCTC READ ONLY

CORRESPONDENCE AND THE STATUS OF THE APPLICATION

1. The program uses five letters in corresponding with applicants. Correspondence triggers a change in the status of the application. The examiner selects the status in the database according to the letter.

2. Correspond only after you’ve entered the entire Form 13441-A into the database and set the status of the application.

3. Enter the applicant’s PIN on all correspondence, to the right of the salutation "Dear Candidate."

4. An applicant’s ineligibility takes priority over defective items in an application. Don’t send letter 4541 if the applicant’s ineligible for the HCTC. Use letter 4540 to notify the applicant of ineligibility. Note in the open paragraph of letter 4540 any defective items in the application that the applicant must correct for a re-submission of Form 13441-A to be considered compete and acceptable.

5. Timeliness of correspondence. The enrollment team will establish the requirements for timeliness of correspondence with the applicant.

6. Retrieve E-faxes on a daily basis. Check E-fax folder daily for replies/missing information. Print reply and associate it with the original submission on suspense wall. Re-batch under OFP 390-84334

7. If the applicant is eligible and an application is incomplete, illegible or otherwise defective correspond, with letter 4541, for perfection of Form 13441-A or supporting documents.

  1. Check the appropriate boxes in letter 4541 before sending the letter to the applicant. Correspond only once.

  2. Correspond for all defective items with the letter

  3. Change the status of the application to "Enrollment determination Application Processing—Waiting for Supporting Documentation" and allow the applicant 45 days for responding. d. A reply is considered late on the 46th day after correspondence.

  4. A reply is considered late on the 46th day after correspondence.

8. Adequate reply: all required information present and acceptable

  1. Add to the database the information the applicant returns.

  2. Change any information in the database the applicant’s changed in the reply.

9. No or inadequate reply: required information missing or unacceptable: applicant’s

response to letter 4541

  1. Decline the application and elevate to work leader. Work Leader will include all deletes on a spreadsheet and send to IT

  2. Set the status of the application to" Participant Enrollment Determination Ineligible: Participant not eligible" . Staple application and an action trail of "declined" edited on the application.

  3. Send the applicant letter 4540 with the explanation "Incomplete registration form" or "Missing supporting documents" , according to the reason for the correspondence. If both reasons apply send both explanations.

10. No or inadequate reply: required information missing or unacceptable: applicant’s

response to letter 4540

  1. Decline the application

  2. Set the status of the application to or keep the status of the application in "Participant Enrollment Determination Ineligible: Participant not eligible"

  3. Send the applicant letter 4540 with the explanation "Incomplete registration form or Missing supporting documents" , according to the reason for the correspondence. If both reasons apply send both explanations.

  4. Copy and paste the text immediately below into the open paragraph of letter 4540.

  5. We have reviewed the documents you submitted in response to our earlier decision that you did not fully support your application for the monthly Health Coverage Tax Credit (HCTC). The new documents do not provide sufficient support for your application for the HCTC either, and we must decline your application for the monthly HCTC

11. Letters and their associated status

  1. There are five letters for correspondence with applicants. The list below shows them and the status of the application associated with the correspondence.

  2. These five letters are catalog letters available in PDF at the Product Catalog

    Letter Purpose Status
    3772 cancellation of registration
    • Enrollment cancelled based on ineligibility for the taxpayer, DoL or the health care provider or

    • Enrollment cancelled based on permanently ineligibility due to over 65 years old, death or two year completion of QFM eligibility

    4540 declination of application
    4541 request for information
    4545 acceptance into program "Completed"
    5758 acknowledgement of receipt

    Note:

    Management authorizes the use of letter 5758

    "Registration application form received"

12. Attach the second copy of all letters to the applicant’s packet.

13. If the applicant responds to letter 4540 and the new documents don’t support the application for the HCTC and you send a second letter 4540 to the applicant write the word "Declined" in the upper right corner of the copy of letter 4540 to be attached to the packet.

LETTER OF ELIGIBILITY

  • Letter of eligibility from the Department of Labor (DoL) or the Pension Benefit Guaranty Corporation (PBGC) and Form 1099-R for the Pension Benefit Guaranty Corporation

  • The Department of Labor issues the letter of eligibility for applicants who receive assistance under Trade Adjustment Assistance (TAA). The applicants may receive benefits through three programs.

  • Trade Readjustment Allowance (TRA)

  • Reemployment Trade Adjustment Assistance (RTAA)

  • Alternative Trade Adjustment Assistance (ATTA)

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ACRONYMS

The table lists commonly used acronyms and their definitions:

Acronym Meaning
ATTA Alternative Trade Adjustment Assistance
COBRA Consolidated Omnibus Budget Reconciliation Act
DPO Document Perfection Operation
DoL Department of Labor
DSRA-BT Delphi Salaried Retirees Association Benefit Trust
HCTC Health Coverage Tax Credit
HPA Health Plan Administrator
PBGC Pension Benefit Guaranty Corporation
RCO Receipt Control Operation
QFMP Qualified Family Member Participant
RTAA Reemployment Trade Adjustment Assistance
SWA State workforce agency
TRA Trade Readjustment Allowance