Form H4851-P, Notice of Administrative Disqualification Hearing

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Documents

Effective Date: 8/2007

Instructions

Updated: 8/2007

Purpose

To provide the household member with

  • 30 days advance notice of the recommendation to disqualify him from the TANF and/or Food Stamp program; the reason for the recommendation; and the date, time and toll-free number and code to place the call for the hearing.
  • information about the administrative disqualification hearing and consequences of the hearing.

Procedure

When to Prepare

The hearing officer completes Form H4851-P at least 30 days before the hearing date.

Number of Copies

Original and four copies.

Transmittal

Mail one copy to the

  • household member by certified mail — return receipt requested;
  • household member by regular mail;
  • worker for the food stamp or TANF case record; and
  • investigator who submitted the case.

The hearing officer keeps one copy.

Mail Form H4851-P with:

  • Form H4855, Statement of Household Member's Rights in Administrative Disqualification Hearing/Procedures for Administrative Disqualification Hearing;
  • Form H4856, Request for Another Appointment for Administrative Disqualification Hearing;
  • Form H4861, Receipt of Notice; and
  • an envelope addressed to the hearing officer.

Form Retention

Keep the case record copy for three years after the case is closed. File the form under the Legal Section in the case record. Destroy all other copies when no longer useful.

Detailed Instructions

In the inside address, enter the household member's full name and address.

Date — Enter the date the form is typed.

OIG Case No. — Enter the Office of Inspector General (OIG) case number.

Individual No. — Enter the client number of the household member recommended for disqualification for intentional program violation.

Appeal ID — Enter the TANF case number or the food stamp case number.

Name of Hearing Officer — Enter the name of the hearing officer.

Office Address and Telephone No. — Enter or stamp the office address and telephone number of the hearing officer.

Day, Date, Time, Toll-Free Number and Code — Enter the day, date, time that the hearing is to be held, and the toll-free number and code that will be used by all hearing participants.

Disqualification Period — Check the appropriate program and time period.