IM-112 Instructions

ACTION TAKEN ON YOUR FOOD STAMP CASE

PURPOSE:   To provide a standard form to notify food stamp EUs of the action taken on a food stamp case for the following reasons:

• The application was rejected because the food stamp case is currently active. For example, the EU tried to recertify more than 60 days prior to the end of the certification period;
• The request for replacement food stamp benefits is approved;
• The request for replacement food stamp benefits is denied and the reason for the denial;
• The request to reduce the claim balance is approved and notifies the EU what the outstanding balance of the claim was reduced to;
• The request to reduce a claim balance was denied and the reason for the denial.

MANUAL REFERENCE: Food Stamp Manual Sections 1120.035.00, 1150.000.00, 1142.055.05

INSTRUCTIONS FOR COMPLETION

FROM

ELIGIBILITY SPECIALIST: Enter the name of the Eligibility Specialist.

TELEPHONE NUMBER: Enter the area code and county office telephone number.

DATE: The system enters the date.

COUNTY OFFICE ADDRESS (STREET, CITY, STATE, ZIP CODE): Enter the county office name and address.

TO

NAME: Enter the EU name.

ADDRESS (STREET): Enter the street address of the EU.

CITY, STATE, ZIP CODE: Enter the city, state, and zip code of the EU.

RE

CASE NAME: Enter the case name.

SCN (SUPERCASE NUMBER): Enter the Supercase Number of the EU.

DCN (DEPARTMENTAL CLIENT NUMBER): Enter the DCN of the EU.

ACTION/REASON

Three boxes are available for selection in the Action/Reason section.

• Check the first box if the food stamp application is rejected because the EU applied more than 60 days prior to the end of his/her certification period. In the second sentence of this selection, enter the last month of the current certification.
  
  
• Check the second box if the EU requested a replacement of food stamp benefits and the request is approved.
  
  
• Check the third box if the EU requested a replacement of food stamp benefits and was denied. Then enter the reason for the denial.

CLAIM ACTION

Three boxes are available for selection in the Claim Action section.

• Check the first box if the request for reduction of a claim balance has been approved. In the second sentence, enter the new balance of the claim.
  
  
• Check the second box if the request for a reduction in the claim amount was denied.
  
  
• Check the third box to explain why the request for reduction of the claim balance was denied and enter the reason for the denial.

FREE LEGAL SERVICES

Enter the phone number for the Legal Aid office providing services to the county office.

SIGNATURE/DATE

The Eligibility Specialist signs and dates the letter.

FAIR HEARING

The EU completes the Request for Fair Hearing section and returns it to the local county office.

NAME OF PERSON REQUESTING A HEARING: The EU enters the name of the individual who is requesting the hearing.

TELEPHONE NUMBER: The EU enters his/her phone number.

ADDRESS: The EU enters his/her address.

TELL US WHY YOU WANT A FAIR HEARING: The EU explains why s/he wishes to have a fair hearing.

DCN: Enter the Departmental Client Number of the EU.

SCN: Enter the Supercase Number of the EU.

ELIGIBILITY SPECIALIST: Enter the name of the Eligibility Specialist for the EU.

DATE NOTICE SENT: The system enters the date when the letter is created.

DATE REQUEST RECEIVED: Date-stamp the date the request for the fair hearing is received in the county office.