MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to remind staff of the appropriate procedures regarding replacement check issues, to notify staff of updates made to the IM-214 Affidavit for Replacement Check and the IM-215 Affidavit of Forgery and to share instructions for these forms and for the IM-206 Check Transmittal.

It is the responsibility of Family Support Division staff to initiate requests for replacement checks when participants report a check was not received, was damaged or lost, or may have been forged. Do not refer participants to the Division of Finance and Administrative Services.

The IM-214 and IM-215 forms are revised as follows:

• All references to caseworker have been updated to eligibility specialist.
• Division of Budget and Finance (DBF) is updated to Division of Finance and Administrative Services (DFAS).
• The DFAS phone number is changed to 573-751-7587. Do not share this telephone number with participants.
• Fields are added for the participant to clearly indicate whether or not s/he wants the replacement check to be issued to his/her home address or to the Family Support Division (FSD) office in his/her county of residence.
• The IM-214 form is to be mailed, or scanned and emailed to DFAS at DFAS.AssistancePayments@dss.mo.gov.
• The original IM-215 form is to be mailed to DFAS on or before the next business date after the form is completed.
• A photocopy of ID is now required along with a completed IM-215 form.
• Instructions for completion of the forms have been integrated into the IM-214 and IM-215.

  NOTE: The completed original IM-215 form and the photocopy of ID must be mailed to DFAS; it cannot be scanned. The address to mail the IM-215 is:

  Division of Finance and Administrative Services
  PO Box 1643, 615 Howerton CT
  Jefferson City, MO 65102.

For further information regarding replacement checks, review Income Maintenance memorandum IM-16 Check Replacement and Interim Reimbursement Procedures dated January 29, 2001 Check Replacement and Interim Reimbursement Procedures.

Instructions for completion of the IM-214 and IM-215 forms have been updated to reflect these changes and added to the online Income Maintenance Forms Manual.

Any checks returned to a Family Support Division office, such as payments made after a participant left a nursing home or previously replaced checks that were later found, must be accompanied by the IM-206 Check Transmittal ledger when submitted to DFAS. The IM-206 has not been revised but instructions for completion of the form have now been added to the Income Maintenance Forms Manual. Review the complete instructions to ensure proper procedures are followed.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Use IM-214 and IM-215 with a revision date of 01/2015 or after.
• Use the IM-206 when returning checks to DFAS.

ATTACHMENTS:

• IM-214 and instructions
• IM-215 and instructions
• IM-206 instructions

AC/cb/mah/tb