B Reviewing the Agreement to Sell Property (DE-165) Form

Program	Manual Section
ALTCS	MA703E

Procedure

An Agreement to Sell Property (DE-165) Form is required for each resource being excluded under the Good Faith Effort to Sell exclusion. Complete the following steps for each DE-165 submitted.

Step	Action
1	Review the case in HEAplus, is the customer resource eligible without the DE-165? If YES, STOP. Inform the customer the agreement is not needed to be eligible for ALTCS. If NO, continue to step 2.
2	Review the DE-165. Did the customer sign the form? If YES, continue to step 3. If NO, skip to step 4.
3	Are both the Power of Attorney and Acceptance of Power of Attorney sections completed according to the instructions on the form? If YES, skip to step 7. If NO, STOP. Inform the customer the agreement cannot be accepted without the sections completed. Once a completed form is provided, return to step 1.
4	Is the customer incapacitated? If YES, continue to step 5. If NO, STOP. Inform the customer the agreement cannot be accepted because it was not signed by the customer, or someone authorized to sign for the customer.
5	Does the signer of the DE-165 have a Power of Attorney from the customer? If YES, continue to step 6. If NO, STOP. Inform the customer the agreement was not accepted because it was not signed by the customer, or someone authorized to sign for the customer.
6	Review the Power of Attorney document. Does the signer have the authority to act for the customer in a financial capacity? If YES, continue to step 7. If NO, STOP. Inform the customer the agreement was not accepted because it was not signed by the customer, or someone authorized to sign for the customer.
7	Does the property have multiple owners? If YES, continue to step 8. If NO, skip to Step 10.
8	Can the partial ownership be sold separately with or without the agreement of the other owners? If YES, continue to Step 10. If NO, continue to Step 9.
9	Is the completed DE-165 signed by each owner, or each owner’s Power of Attorney when the owner is unable to sign? If YES, continue to Step 10. If NO, STOP. Conditionally exclude the only resource that is unavailable and meets the conditions in MA703A or MA704B.
10	Process the case, excluding only the resources with agreements that are needed to allow the customer to be resource eligible. Complete the acceptance of agreement section of the DE-165 on or before the approval date in HEAplus. On the same day the case is approved, mail a copy of the completed DE-165 to each owner who signed the agreement and to the agent appointed as the Power of Attorney (if applicable). NOTE When an applicant’s approval for ALTCS benefits is based on the conditional exclusion of non-liquid resources, the customer will be notified in writing that the agency has accepted the agreement.
11	Set a calendar appointment (including your supervisor) to contact the customer 35 days after the date the acceptance agreement section of the DE-165 is signed by the agency and every two months thereafter to obtain proof of continuous reasonable efforts to sell. NOTE The date of acceptance is 5 days from date the local office signs and mails the acceptance agreement unless the customer shows us that he/she did not receive it within the 5-day period. If the copy of the DE-165 proving agency acceptance is handed to the client, the date of acceptance is that date. If the customer is also notified of the acceptance by phone, document the verbal notification date on the Case Recordings (DE-114).
12	After 35-days, contact the customer by telephone and document in the case notes the customer’s claims about efforts to sell the resource, offers to buy the resource since the prior contact, and claims of good cause in the absence of continuous reasonable efforts to sell.