IM-89 Instructions

AGENCY REPRESENTATIVE FOOD STAMP HEARING CONTROL LOG

PURPOSE:   Provides a control for the Agency Witness, Eligibility Specialist, or Supervisor to record time elements involved in the hearing process, and provides a monitoring system to determine that hearing standards on certain Food Stamp decisions are met. This form is also used for statistical purposes for the Lambus v. Walsh report.

NUMBER OF COPIES AND DISPOSITION:   This is an online form only and is completed for all Food Stamp hearings EXCEPT disqualifications, claims, and dismissed (i.e. individuals who do not appear for the hearing) or withdrawn (i.e., the county office decides to withdraw its proposed action). Complete this form within 10 days of receipt of the signed Decision and Order is date-stamped as received in the county office.

Submit a copy to State Office Program and Policy Unit (Food Stamps) either by E-mail to Deborah.A.Henry@dss.mo.gov, or fax it to the Program and Policy Unit (Food Stamps) at (573) 522-4333 within ten days of receipt of the hearing decision in the county office. The form may also be mailed to Program and Policy (Food Stamps) through regular State Office mail. Retain a duplicate copy at the county office for three years after the final decision date.

Take the following steps to send a copy via E-mail to the Food Stamp Unit:

• obtain the form from the IM Forms Manual on the Intranet;
• complete the form;
• save the form as a word document; and
• insert the form in an E-mail and send it to the E-mail address listed above

INSTRUCTIONS FOR COMPLETION:

1. Case Name: Enter claimant’s full name as shown on the Food Stamp case.

2. Type of Assistance: No entry required. This form is only used for Food Stamps.

3A. DCN (Departmental Client Number): Enter the claimant’s 10-digit DCN.

3B. Supercase Number: Enter the claimant’s supercase number.

4. County Number: Enter the county number.

5. Eligibility Specialist/Load/Unit: Enter the name of the Eligibility Specialist involved in taking the adverse action and his/her load number. Enter name or number of the unit who completed the IM-87.

6. Hearing Number: Enter the complete hearing number shown on the Decision and Order. For example: 9999-FS-FY06JC, KC, or STL.

7A. Adverse Action: List the form created to notify the claimant of the adverse action which resulted in the request for a hearing (i.e., FA-510, FA-150, IM-112).

7B. Action: Check the appropriate box for the proposed adverse action. An example for each reason is listed below.

• Rejection - i.e. a Food Stamp application or individual was rejected for Food Stamps.
  
  
• Closing - i.e. a Food Stamp case is being closed. For example, a one-person EU is closed because s/he is a fleeing felon or imprisoned.
  
  
• Adjustment - i.e. the case is adjusted because at the time of application it was declared a change would occur and the change has been completed.
  
  
• Remove a person - i.e. the EU has applied for Food Stamps individually.
  
  
• Sanction - i.e. the claimant did not cooperate with METP, does not want to provide a Social Security Number for an EU member.
  
  
• Other - i.e. the claimant disagrees with denial of Food Stamp replacement.

8. Hearing Request Date: Enter the date the claimant requested the hearing.

9. Date Hearing Held: Enter the date the hearing was conducted.

10. Was hearing rescheduled? Answer yes if the hearing was rescheduled from its original date. If the hearing date was changed, complete responses 10A, 10B, and 10C.

10A. Date Hearing was originally scheduled: Enter the date the hearing was originally scheduled.

10B. Was hearing rescheduled more than once?: Check yes if the hearing was rescheduled more than one time.

10C. If yes, who requested rescheduling(s), for what reason(s), and date(s)?: For each time a hearing was rescheduled, explain who requested the date change (i.e. Agency, client, client’s attorney, etc.), the reason it was requested to be changed, and the date the change was requested.

11. Date of Decision (Director’s Signature Date): Enter the date the Decision and Order was signed by the Director.

12. Date Decision Received in County Office: Enter the date the county office received the Decision and Order.

13. Decision: Of the four responses available, check the appropriate box. If explanation is necessary, use the comments section.

• A. Check this box if the Agency was affirmed (upheld) in the Decision and Order and the claimant’s benefits remained the same during the hearing process.
  
  
• B. Check this box if the Agency was affirmed in the Decision and Order, and the claimant’s benefits were either reduced or stopped during the hearing process.
  
  
• C. Check this box if the Agency was reversed in the Decision and Order and the claimant’s benefits remained the same during the hearing process. A response is required for items 13E, F, and G.
  
  
• D. Check this box if the Agency was reversed in the Decision and Order and the claimant’s benefits were either reduced or stopped prior to the hearing. A response is required for items 13E, F, and G.

13E. Final Action Taken: If the Agency was reversed for either c or d above, enter what action was taken when the county received the signed Decision and Order. For example, case was cancel closed and benefits issued. Enter comments in EUMEMROL in FAMIS.

13F. Date Final Action was Completed: Enter the date the Eligibility Specialist entered and approved the final action taken in 13E above.

13G. Reason(s) for Delay in Implementation: Enter the reason the Eligibility Specialist did not implement the final action in a timely manner based on Food Stamp policy.

14. Comments: Enter comments, as appropriate.

15. IM-89 Contact Person: Enter the name of the individual who completed the IM-89.

16. Telephone Number: Enter the telephone number of the contact person for the hearing.