- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- APPLICATION FOR STATE HEARING IS REVISED
- FORMS MANUAL REVISION: #2
DISCUSSION:
The purpose of this memo is to introduce revisions to the Application for State Hearing (IM-87) form and instructions. Changes to the form include the following fields:
- Changing Supercase Number to Case Residence County in field 7
- Changing County to FSD Office of Action in field 8
- Adding name and DCN of person the hearing is for or about, if different than case name in field 12
- Adding Eligibility Specialist Supervisor (ESS), telephone, and extension number to field 26
- Clarifying that the hearing request is scanned and emailed to the Hearings unit in field 27
- Clarifying that the exhibits or follow-up documents are mailed to the Hearings unit in field 28
- Adding field 31 ES or ESS will be participating from FSD office; and
- Adding field 32 claimant will be participating from FSD office.
Eligibility Specialists (ES) must complete all applicable fields of the Application for State Hearing form. When the Eligibility Specialist Supervisor (ESS) or their designee signs the form they are attesting that they have reviewed the form to ensure that all appropriate areas of the form are completed correctly.
The ES or ESS is still responsible to call the Administrative Hearings unit to inform them when the claimant arrives for the hearing.
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.
NECESSARY ACTION:
- Review this memorandum and the revised Application for State Hearing (IM-87) form and instructions with appropriate staff.
- Begin using the revised Application for State Hearing (IM-87) form and instructions immediately.
- Destroy/recycle all versions of the IM-87 with a revision date prior to January 2013.
ATTACHMENT:
AC/jo