Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: FORM REVISIONS COMPLETED FOR HEARING WITHDRAWAL FORMS
FORM REVISION #
Form revisions were completed for hearing withdrawal forms that are used by Income Maintenance (IM) staff. These forms were changed to reflect updated terminology and for improved formatting. All forms are available as fillable PDF documents. The forms and corresponding instructions were added for staff use to the IM Forms Manual.
Policy regarding administrative hearings has NOT changed.
Withdrawal of Request for Hearing (IM-90) may be completed by Family Support Division (FSD) staff by phone or in person while working with participants.
Agency Action Rescinded (IM-90A) is to be completed by the FSD agency witness assigned to the requested hearing. This form is sent to the Administrative Hearings Unit to rescind a hearing.
Agency Action Withdrawn Participant Notification (IM-90B) is to be completed by the FSD agency witness assigned to the requested hearing. This form is sent to the participant to notify them that the agency has rescinded the action and the hearing has been cancelled.
- Review this memorandum with appropriate staff.
- Begin using IM-90, IM-90A, and IM-90B forms with revision date of 10/2021 immediately.
- Discard any forms with older revision dates.