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