Quality-control questions and answers, Change 1

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| U.S. DEPARTMENT OF LABOR | CLASSIFICATION |
| Employment and Training Administration | |
| Washington, D. C. 20210 | UI/QC |
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| | CORRESPONDENCE SYMBOL |
| | |
| | TEUQI |
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| | ISSUE DATE |
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| | September 18, 1987 |
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| RESCISSIONS | EXPIRATION DATE |
| | |
| | February 28, 1998 |
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| DIRECTIVE | : | UNEMPLOYMENT INSURANCE PROGRAM LETTER NO. 08-87, Change 1 |
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| TO | : | ALL STATE EMPLOYMENT SECURITY AGENCIES |
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| FROM | : | DONALD J. KULICK |
| | | Administrator |
| | | for Regional Management |
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| SUBJECT | : | Answers to Questions and Comments Raised Concerning the Unemployment Insurance Quality Control (UI/QC) Program |
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1. Purpose. To transmit answers to questions raised concerning the UI/QC system since the issuance of UIPL 8-87.

2. Reference. ET Handbook No. 395, ET Handbook No. 396, UIPL 52-86 and UIPL 8-87.

3. Background. Many questions and comments on the UI/QC program have been raised since the issuance of UIPL 8-87. In keeping with our commitment to keep State Employment Security Agencies (SESAs) informed and encourage uniform QC methodology, the answers to these questions and comments are being transmitted to SESAs for their information.

   The questions and answers are grouped by subject matter for ease of reference. Information Provided in the attachment to this UIPL will be incorporated, as needed, in future revisions to ET Handbook Nos. 395 and 396.

4. Action Required. SESA Administrators are requested to provide this in information to appropriate staff and other interested parties.

5. Inquiries. Direct questions to your appropriate Regions office.

6. Attachment. Questions and answers.

Attachment (https://oui.doleta.gov/dmstree/uipl/uipl87/uipl_0887c1a.pdf)

ATTACHMENT TO UIPL 8-87, Ch. 1

A. POLICY- AND GENERAL QUESTIONS

1. Q. QC methodology calls for reviewing ES •5l1's and verifying job referrals. Should ES
   be made aware of this activity?

A. Yes. Because QC is conducting an independent evaluation of UI payments that may include several units within the SESA, QC should make every attempt to work cooperatively with these other units and to keep them aware of QC activities.

2. Q. When QC refers a ca.se to the fraud unit for disposition, how should time be
   charged?

   A. Time charging is an internal agency issue.

3. Q. Chapters II through VIII of ET. Handbook No. 395 are labeled "Required Procedures"
   in the Handbook's Table of Contents.Does this mean that all of these chapters are
   subject to Federal monitoring?-

   A. Yes. All aspects of the established QC methodology will be reviewed by regional
   monitors. The specific reviews that will be conducted are described in ET . Handbook
   No. 396 which was distributed to all Regional Offices and States on August 1, 1986.

4. Q. Page VI-1 2(a) General Investigative Requirements in ET. Handbook No. 395 states
   that all decisions of the QC unit must be based on the State written law and policy,
   available to the public. There are innumerable situations which are not covered
   (defined) by written laws or policies. The interpretation of laws and policies, within
   boundaries, is left to the discretion of individual staff. How is the QC unit to handle
   such situations?

   A. It should be the objective of the QC unit to evaluate the accuracy of UI payments by
   applying State law and policy so that uniform and consistent findings would arise
   from the same facts. The QC unit, as part of the formal UI system in the SESA, must
   know the SESA's laws ad policies to properly evaluate each sampled payment.

     The question implies two kinds of situations in which law and policy are not clearly
     enunciated or do not exist. In the first situation an operational practice exists, but is
     not defined or supported by written law or policy. An example of this type situation
     is: a UI fraud unit will not establish a fraud overpayment of less •than $1000.00
     even though no formal agency policy supports this practice . In such situations, the
     QC unit should make every effort to obtain from the appropriate UI authority the
   
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   formulation and issuance of a supportive policy statement. If an amendment or
   modification of existing UI law is needed, QC should recommend such legislative
   effort by SESA management.
   
   The second situation is one in which interpretation and application of general law
   and policy to particular circumstances are left to the discretion of individual staff.This
   occurs frequently in the area of availability_ issues. The QC unit should make every
   effort to obtain more sharply defined UI policy covering various common factors
   which affect eligibility, and which help define the boundaries of discretion in applying
   the policy. When the boundaries of discretion have been narrowed as much as
   possible, QC investigators will be able to apply agency policy more consistently . If
   the boundaries are still broad, it is important for the QC unit to keep in mind that
   QC methodology call for "investigations to begin with the assumption that the Key
   Week was properly paid". This means that findings of error would only occur where
   the original application of the broadly defined policy resulted in a decision which was
   out of bounds.
   

B. INVESTIGAIIVE PROCEDURES

1. Q. Is it necessary to pursue non key week issues until a supportable conclusion is
   reached? If these issues are referred to other units, it may take a substantial amount of
   time for the issue to be resolved. Can a case be closed if non-key week action has not
   been completed?

   A. The response to both questions is a qualified Yes. QC methodology requires that
   "investigators must conduct new and original fact-finding … on all issues which have
   not been detected previously or for which it is questionable that they were properly
   treated. The issues must be pursued until a supportable conclusion is reached.(Non-
   key week issues should be referred to other SESA staff for pursuit and resolution
   unless adjudication by QC staff would only involve incidental time and resources.) A
   case is complete when… all official actions for the key week…have been completed.

   Therefore, a QC case can be completed without non-key week issues being
   completed. However, the QC unit must track all non-key week issues until disposition
   (including formal action) and must enter this information in DCI items H-9/H-10. All
   documentation for these issues must be included in the QC case file. Federal
   monitors will review these non-Key Week issues to determine that pursuit,
   disposition and accurate DCI entry occur.
   

2. Q. Can the National Office define what are considered "reasonable attempts" to obtain
   QC information in-person and what are "compelling reasons" for not obtaining QC
   information in-person?

   A. Chapter VI of ET. Handbook No. 395 requires that all phases of the QC investigation
   are to be conducted in-person. It is also understood that in every case, this may not
   be possible and the methodology allow for those extreme situations.

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     Section 5 of Chapter VI states that “if it is not possible for the investigator to
     conduct the (claimant) interview in-person, the investigator must detail … attempts
     to interview the claimant in-person and the reasons why other means were used to
     complete the questionnaire."
   
     Section 6 states that investigators must document "if there were compelling reasons
     why the in-person interview could not be conducted." Section 7 requires the
     investigators "to detail attempts to interview the employer in-person and reasons
     why other means were used to obtain the information. "
   
     It is not feasible to define "reasonable attempts" and "compelling reasons" since
     exceptions are to be dealt with on a case-by-case basis. However, it -is possible to
     provide a few examples which have occurred and are not acceptable. Monitors have
     reviewed cases that contain investigator statements such as "claimant moved" or
     "employer in an area where no other cases are located". These statements standing
     alone are not reasonable attempts to obtain required QC information in-person.
   
     In the formal QC training provided by the National Office, considerable time was
     devoted to investigative techniques that included how to locate claimants and
     employers. These techniques should be used by investigators to locate and obtain
     QC information.
   

C. DATA PROCESSING

Not applicable

D. DATA BLEMENTS

1. Q. When should the snapshot be taken for each element? When there is not a before or
   after field, should QC use what was reported or what the field should have been?

   A. The QC Investigative Guide (Appendix C to ET. Handbook No. 395) should be used
   to determine the correct entry for data elements. The Action Required column of
   the Guide describes the verification necessary before an entry is made.

2. Q. Element C-6 - Number of ERPs Held. Current Benefit Year. A claimant is in the
   Eligibility Review Program but as of the Key Week investigation has not had the first
   interview - (i.e. ERP scheduled for week 10, KW is week 5). Should this be recorded as a
   "0" or "x"?

   If "x" is used, how does the State distinguish those claimants required to have an ERP
   who have not reached the scheduled date from those not required to be in the ERP
   program? It appears we are losing some data for analysis.

   A. If the claimant is in the ERP Program but has not reached the scheduled interview
   date, Code "x" is used. This is because the claimant was not required to have an
   ERP earlier than the key week. So the lack of an ERP could not reasonably be held to
   affect the propriety of the key week payment.

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     It is true we cannot distinguish between the individuals recorded as "x" that
     were/were not in the ERP Program. However, these fields were intended to provide
     analysis on claims where lack of an ERP might have contributed to an improper
     payment.
   

3. Q. Element C-8 - Number of Prior Nonseparation Issues Disposed of. Should one enter
   the number of issues or the number of dispositions? (Wording of C-8 in instructions says
   "issues" in the first sentence and "dispositions" in the second sentence}. Also, what is
   the difference between formal and informal dispositions?

   A. The intent of the element is to code the number of nonseparation determinations in
   the current benefit •year through the Key Week. Nonseparation determinations
   relate to the claimant's continuing eligibility to receive UI benefits and will provide
   input to identify errors and the accuracy of eligible determinations. The only
   difference between formal and informal dispositions is that informal dispositions are
   generally eligible determinations and therefore, a formal notice is not given/mailed
   to the claimant.

4. Q. Element D-1 - Reason for Separation before Investigation. If there is never a break
   in filing, but the claimant shows some earnings and then a separation, an additional
   claim count may never be taken even though a nonmonetary determination may be
   issued. According to definition, this employer would never be used for QC coding. Is this
   the intent of Element D-1.

   A. Yes. The intent of item D-1 is to show the most recent separation for which an
   official new claim or additional count can be taken. This separation cannot include an
   adjudicable separation if a new or additional claim count cannot be taken using
   workload validation definitions. This information will be used to assess States
   'conformity to their own laws and compliance with Federal laws.

5. Q Element E-1 & E-2 - Number of Base Period Employers Before Investigation & Base
   Period Wages Before Investigation. Why do all employers and wages need to be
   verified? Some States may not use all this information.

   A. The intent of items E-1 & 2 is to provide information on how accurately employers
   are reporting wages that are used in establishing a claim. States have different
   formulas for calculating the WBA and MBA of claims including the amount of wages
   that is taxable . A common starting point for these calculations is the total wages
   paid to the claimant by the employer. Therefore, for item E-2, all wages for any
   employer identified in E-1 should be coded. See UIPL 53-86 dated 8-14-86, Section
   B, Question 8 for prior clarification.

6. Q. Element F-5 - Original Amount Paid and/or Offset for Key Week. Should dependents
   allowance be included?

   A. Yes .

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7. Q. Element G-10 - Number of Job contacts Listed for Key week. On the claimant
   Questionnaire, Question 43; instructions say to include unions and private employment
   agencies. Shouldn't this say include referrals to job openings by unions and private
   employment agencies? Or do we want claimants to list contacts with unions and private
   agencies? This has led to confusion on OCI item G-10 as to whether or not contacts with
   unions and private employment agencies should be included.

   A. The area of unions/referrals and private employment agencies/referrals needs to be
   applied using State law and policy. Question 43 is designed to gather information
   about job contacts. If the State considers contacts with the union or the private
   employment agency as a work search contact, then those contacts should be
   required to be listed in question 43 and counted in G-10. On the other hand, if such
   contacts in themselves are not considered work search contacts, union and private
   employment agencies should not be listed in question 43 of the questionnaire.
   Instead, the SESA should modify question 43 to reflect the State's law and policy.

8. Q . Elements H-1 to 8 - Error Classification Information. One SESA issues two
   determinations when fraud is involved in a case--one establishes misrepresentation and
   the other, the reason for the disqualification, is established as a recoverable non-fraud
   overpayment. In this situation, should QC code two separate issues?

   A. One issue has arisen, even though the SESA pursues it with two separate actions.
   Therefore, QC must select the more appropriate action to code, in this case the
   fraud issue. Additional information necessary to record the facts of the case is
   captured by the QC coding system, i.e., responsibility, cause, etc.

9. Q. Element H-9 & 10 - Total Whole Amount of Overpayments (item 9) or
   Underpayments (Item 10 - include Key week. Should the dollar amount coded be the
   total dollar amount established or just the amount for the benefit year containing the
   Key Week?

   A. The intent of items H-9 & 10 is to show the dollar amount of all official actions that
   resulted from the QC investigation of the claimant. This may cover more than one
   benefit year. This can be used to record the effectiveness of QC investigative work.

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