- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- IM-87, APPLICATION FOR STATE HEARING
- FORMS MANUAL UPDATE #8
DISCUSSION:
Effective immediately, Form IM-87, Application for State Hearing, is revised. The changes to the form and to the instructions for completion of the form are listed below.
- Added additional program types in the “Category Being Appealed” section of the form.
- Revised terminology by changing references from “DWD” to “DWD/MWA”.
- Revised instructions regarding number of copies and disposition of the form.
- Revised instructions regarding the method for submitting the IM-87 to the Administrative Hearing Unit.
- Revised/updated instructions regarding the time frames for submitting the completed IM-87 form to the Administrative Hearing Unit.
- Added clarifying instructions in the “County” field regarding entries required if county has more than one office or if the county is served by a DSS Resource Center.
- Updated instructions in the “Date of Action Notice for which Hearing is Requested” field by providing examples of entries needed in this field.
- Added an additional section to the IM-87 entitled “Eligibility Specialist Schedule & Scheduled Time Off.” The IM-87 forms instructions were revised to include information on how to complete this portion of the form. This new section on the IM-87 form was added in order to assist the Administrative Hearing Unit in scheduling hearings.
The IM-87 PDF and WORD versions are available in the online IM Forms Manual on the FSD Intranet. A printed form will not be available from the warehouse.
Destroy/recycle all versions of the IM-87 with a revision date prior to October 2011.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Destroy/recycle all versions of the IM-87 and instructions with a revision date prior to October 2011.
KEH
Attachments:
IM-87, Application for State Hearing
IM-87, Instructions