| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | FORM IM-87, APPLICATION FOR STATE HEARING AND
INSTRUCTIONS
FORMS MANUAL REVISION #9: IM-87, APPLICATION FOR STATE HEARING AND INSTRUCTIONS |
DISCUSSION:
The Application for State Hearing (IM-87) form 
and instructions are revised. The overall appearance of the form is changed. Each section in the gray areas in the top portion of the form requires an entry by staff. Missing information not only delays the Hearings Unit from scheduling the hearing but creates the potential for the hearing process to exceed the 60-day time limit as outlined in the Food Stamp Regulations and Lambus v Walsh lawsuit.
Other changes are as follows:
- General Relief (GR) and Medical Assistance for Working Disabled (MAWD) are removed from the Categories Being Appealed section;
- SSN is changed to read SSN of Sanctioned Individual;
- the fields for Case DCN, Supercase Number, County, Claimant is Appealing, Date Hearing Requested, and Reason for Planned Action or Decision by Agency are not changed but are moved to the top of the form;
- Date of Notice or Decision is Appealed From is changed to Date of Action Notice for Which Hearing is Requested and is moved to the top of the form;
- Name is changed to read Name of Person Requesting Hearing;
- Name of Person Requesting Hearing and Telephone Number are moved to the white section of the form; and
- Caseworker is changed to eligibility specialist;
When a hearing is requested on the Ticket to Work program, check the “Medical Assistance” box and write in “Ticket to Work”.
The white areas are completed by the individual requesting the hearing. If the individual requesting the hearing calls the office, enter what s/he said as to why s/he is requesting the hearing. If the individual sends in a written request for a hearing, attach a copy of the written request to the IM-87. In Section 4 of the IM-87, refer the Hearings Unit to the written request attached to the form.
The forms instructions are revised.
An initial shipment of the Application for State Hearing (IM-87 ) is being sent to the county offices. Upon receipt of the initial shipment, destroy/recycle all versions of the IM-87 prior to 06/07. This form is available from the warehouse and can be obtained by using normal ordering procedures. Use of the tri-color carbonless form is preferred, but the form is also available for print in the IM Forms Manual, Volume II.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Destroy/recycle all versions of the IM-87 prior to 06/07.