Department of Human Services: Chapter 10: Sections 10.1 thru 10.6

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IMA POLICY MANUAL
PART VIII: CASE MAINTENANCE

Chapter 10: Notice of Adverse Action

Introduction 10.1

ALL

Before taking any adverse action that reduces or terminates assistance to a recipient, the SSR will send the recipient a written notice that describes the action to be taken (including the amount of any benefit reduction), the reason for the reduction or termination, the effective date of the action, and the right to a hearing to contest the action (see Chapter 7: Grievances and Fair Hearings in this Part).

All notices to applicants/recipients must be in writing and contain the following information:

Action to be taken
Reason for the action
Effective date of the action
Right to appeal or request a fair hearing

In most cases, ACEDS will produce a standard notice. Some circumstances require the SSR to customize the standard notice.

There is one exception to the requirement that the Department issue a notice of adverse action, even though the change(s) results in a reduction in benefits. When the federal government mandates a mass change be made in certain FS program parameters, no notice of adverse action is required except in cases in which all benefits will be terminated. The Department can choose to issue such a notice (see Section 9.6: Required Notices for Mass Changes in this Part).

Legal Authority 10.2

AREA/TOPIC	DISTRICT	FEDERAL
Notice of Adverse Action	ALL: D.C. Code 205.55	MA: 42 CFR 431.206-.214, 435.919 FS: 7 CFR 273.13

Time Standard for Issuance of Notice of Adverse Action 10.3

ALL

Except as noted below in Section 10.5: Exceptions to Timeliness Requirements in this Chapter, Department adverse action notifications must be adequate and timely. A notice meets the timeliness standard if it is issued 15 days before the effective date of action.

Notice of Change in Benefits 10.4

ALL

If the household's benefit level decreases or the household becomes ineligible as a result of the change, the SSR will issue the appropriate notice of adverse action within ten days of the date the change was reported.

If there are 15 days between the date the notice is mailed and the end of the month, the change must be made effective in the month following the month in which the notice was issued. If there are not 15 days between the date the notice was mailed and the end of the month, the change must be made effective in the second month following the month the notice was sent.

For a discussion of the exceptions to the 15-day timeliness requirement for adverse actions, see Section 10.5: Exceptions to Timeliness Requirement in this Chapter.

Example 1

Ms. Manning is receiving TANF benefits for herself and daughter Phoebe who has gone to live with her father in Georgia. On July 7, Ms Manning contacts her assigned SSR to inform her that Phoebe has not resided with her since the first of the month. The SSR should send a notice of adverse action on July 8th, informing Ms. Manning that the TANF grant will be terminated effective August 1st.

Example 2

On August 25, the SSR is informed that Mr. Larde, who receives FS in a one-person group, failed to comply with FSET requirements. On August 26, the SSR issues a FS termination notice. Because there are not 15 days between the date the notice was issued and September 1st, the termination is effective October 1st.

Exceptions to Timeliness Requirement 10.5

ALL	The following are the only circumstances under which timely notice does not have to be provided (note that under these circumstances, adequate notice must be provided): Agency has factual information confirming the death of the recipient. In the case of TANF, this exception to notice only occurs when no other relative can serve as the payee Recipient requests - in writing - that his/her case be closed Recipient has been accepted for assistance in another jurisdiction and that fact has been established by the Department
MA	N/A
TANF	In addition, when a reduction or termination of benefits is required based on information submitted on a TANF quarterly report, the timeliness standard does not apply. An adequate notice must be sent in this circumstance. While the notice does not have to be sent 15 days prior to the effective date of the action, it must be sent such that it is received by the customer prior to or on the effective date of the action.
GC	N/A
FS	See TANF. Also, when an individual is disqualified based on a finding of IPV, an adequate notice must be sent prior to the effective date of the termination, but the 15 day standard does not apply.

Notices of Returned By Mail 10.6

ALL

If the Department mails any form of communication to a recipient and the correspondence is returned indicating that the applicant/recipients whereabouts are unknown ('Return to Sender'), the SSR will send a notice indicating that all benefits will be terminated. The notice must be issued even if it is likely it too will be 'Returned to Sender.' The 15-day timeliness standard must be adhered to in these cases as well.

Example

The Department sends Ms. Combs a notice to come to DHS for an appointment on August 2nd. On August 10th the letter is returned to the Department and stamped "Return to Sender." The SSR should issue a benefit termination notice. The case cannot be terminated prior to 15 days after the termination notice was sent.

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