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 ADMINISTRATIVE DISQUALIFICATION HEARING FORMS
FORM REVISION #
Form revisions were completed for forms that are used by Income Maintenance (IM) staff and by the Administrative Hearings Unit (AHU) for participants requiring an Administrative Disqualification Hearing.
Advance Notice of Your Administrative Disqualification Hearing (IM-160) was updated for formatting and to add information for the participant regarding the purpose of the hearing.
Waiver of Administrative Hearing Disqualification Consent Agreement (IM-161) was updated for formatting.
Withdrawal of Waiver of Administrative Hearing Disqualification Consent Agreement (IM-161A) was updated for formatting and published as a fillable PDF. The IM-161A is available to participants, advocates, and staff in the DSS Manuals IM Forms Manual.
A new form packet Administrative Disqualification Packet (IM-160P) has been added for staff use to the IM Forms Manual. This form contains linked versions of the IM-160, IM-161, and IM-161A.
- Review this memorandum with appropriate staff.
- Begin using the IM-160, IM-161, and IM-161 with revision dates of 10/2021.
- Discard any out of date forms.