| REQUEST DATE: |
- List date client requested fair hearing.
- List date of pre-hearing conference.
- List which program(s) fair hearing is requested for.
|
| ISSUE: |
Summarize the issue
chronologically. |
| FACTS OF CASE: |
In narrative form,
address each of the following:
- Why was an adverse action taken?
- Cite all applicable manual sections.
- Any policy clarification on issue?
- Was correct notice sent?
- Conciliation attempted by caseworker?
- Was policy explained to client?
- Does good cause apply? Why/Why not?
- Were continued benefits addressed?
|
| CLIENT CONTACT: |
- Was conference by phone or in person?
- If unable to contact client by phone, was notice sent to
client?
- Was client advised of their right to legal representation
(i.e. AK Legal Services, Disability of Law Center, etc.)?
|
| STATUS: |
- Was part of or all issue(s) resolved?
- Will client receive continued benefits?
- State date fair hearing request forwarded.
|