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					                  FAMILY INDEPENDENCE ADMINISTRATION
                      Seth W. Diamond, Executive Deputy Commissioner


James K. Whelan, Deputy Commissioner                          Lisa C. Fitzpatrick, Assistant Deputy Commissioner
Policy, Procedures and Training                               Office of Procedures


                                  POLICY BULLETIN #07-87-OPE

           REVISION TO CONFERENCE AND FAIR HEARING EVIDENCE PACKET
                         PREPARATION DESK AID (W-206C)

        Date:                                                 Subtopic(s):
    July 16, 2007                                             Fair Hearing

   This procedure can     The purpose of this policy bulletin is to inform all Job Center staff that
now be accessed on the    the Conference and Fair Hearing Evidence Packet Preparation Desk
FIAweb.                   Aid (W-206C) is being revised to include form replacements and
                          changes in required documents and program names. This policy
                          bulletin serves as information for all other staff.

                          The form changes are as follows:

See PD #05-42-SYS             •   Application/Job Profile (W-680B) was made obsolete and has
                                  been replaced by the Statewide Common Application
                                  (LDSS-2921).
See PB #07-31-OPE
                              •   Request for Emergency Assistance for an Active PA Case
W-145N and W-145P                 (W-145N) and Notice of Acceptance/Denial of
were made obsolete.               Request/Application for Emergency Housing Aid (W-145P)
                                  were made obsolete and have been replaced by the Request
                                  for Additional Allowance or Change (W-137A) and Action
                                  Taken on Your Request for Emergency Assistance or
                                  Additional Allowance (For Participants Only) (W-137B).

                              •   Reference made to the Personal Roads for Individuals’
                                  Development to Employment (PRIDE) program has been
                                  removed as was Section A. FTC with Back to Work PRIDE
                                  Vendor under the issue of Infractions, as the program no
                                  longer exists.

                              •   The reference made to TAD Referral Letter (LDSS-3517)
                                  under Documents Required for Part G. Separate Food
                                  Stamps Determination for Ineligible for Public Assistance was
                                  removed, as it was an incorrect statement.


                                HAVE QUESTIONS ABOUT THIS PROCEDURE?
                         Call 718-557-1313 then press 2 at the prompt followed by 765 or
                                        send an e-mail to FIA Call Center

                                                   Distribution: X
                                                                                  PB #07-87-OPE
                              •   Notice of Intent to Change Food Stamp Benefits (LDSS-3620,
                                  LDSS-3621) under Documents is now listed as two separate
                                  forms:
                                         Notice of Intent to Change Food Stamp Benefits
                                         (Timely and Adequate) (LDSS-3620 NYC)
                                         Notice of Intent to Change Food Stamp Benefits
                                         (Adequate Only) (LDSS-3621)

                              •   Important Notice to All Food Stamp Recipients (W-138XX)
                                  has been made obsolete and replaced by the Food Stamp
See PB #06-74-OPE                 Change Report form (LDSS-3151).

                              •   References to Food Stamp Budget Calculation (WINR0154)
                                  were replaced by Food Stamp Budget Calculation Report for
                                  NPA and NPA-SSI Cases (WINR0153).

                              •   References to HSS/WeCARE were changed to WeCARE.

                              •   References to SAP or ESP/SAP were changed to Back-to-
                                  Work.

                          Center Directors must ensure that all previous versions of the
                          W-206C are removed from circulation and recycled.

                          Effective Immediately

   Please use Print on    Attachments:
Demand to obtain copies
of forms.                 W-206C       Conference and Fair Hearing Evidence Packet
                                       Preparation Desk Aid (Rev. 07/16/07)




FIA Policy, Procedures and Training                    2                      Office of Procedures
Form W-206C (page 1)                                                                                                                                                       Human Resources Administration
Rev. 7/16/07                                                                                                                                                             Family Independence Administration
                                            Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                      For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                           The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.
                          Issue                                          Document(s) Required                                        Source(s)
     Public Assistance Cases
     Denial
     •   Failure to comply with eligibility process              Statewide Common Application (LDSS-2921), Action Taken on Your                           POS/HRA Viewer
     •   Failure to return requested eligibility                 Application (LDSS-4013A NYC, LDSS-4013B NYC)
          documentation                                          Documentation Requirements (W-113K)                                                      POS/HRA Viewer
     •   Denial of special grants                                Case Notes/History Sheet (W-25)                                                          NYCWAY (100A)/POS/HRA Viewer
     •   Excess income/resources                                 Pending Actions and Outstanding Items (NQCS07) screen                                    POS/WMS
     •   Ineligible for other reasons                            Pending Transaction Control Detail List (NQCS7A) screen                                  POS/WMS
     •   Withdrawal                                              Mandatory Dispute Resolution (MDR) Summary (W-204R)                                      HRA Viewer

                                                                                Specific Required Information
     A. Failure to Report/Failure to Comply
        (FTR/FTC) with Eligibility Process
                                                                 Appointment Notice                                                                        NYCWAY
          1.   Failure to Keep BEV Appointment                   BEV Results                                                                               WMS – Selection 13 (MAPPER)
                                                                 Activity Inquiry screen                                                                   NYCWAY
          2.   FTR/FTC WeCARE                                    Notice of Intent (NOI)/Client Notice System (CNS)                                         Web Coins/WMS
                                                                 Medical Provider Appointment (W-538C)                                                     NYCWAY
                                                                 Activity Inquiry screen, Employability Plan                                               NYCWAY/HRA Viewer
                                                                 WeCARE Wellness Plan                                                                      HRA Viewer
                                                                 WeCARE Medical Report (signed acknowledgement/goals)                                      HRA Viewer
                                                                 Notice of Termination                                                                     HRA Viewer
          3.   FTC with AFIS Requirements                        Finger Imaging Notice (W-519)                                                             POS/HRA Viewer
                                                                 Finger Imaging Report Routing Slip (W-519C)                                               POS/HRA Viewer
                                                                 WMS External Clearance Report                                                             WMS
          4.   Excess Income/Resources                           Computer match, NADA book value, life insurance policies                                  POS/WMS/HRA Viewer
                                                                 Pay stubs/award letters/titles/loans and stock information                                POS/HRA Viewer
               (Unreported by applicant; appearing on a          Budget (saved and current)                                                                POS/WMS
               computer match)                                   Other documentation of earned/unearned income or resources                                POS/HRA Viewer
                                                                 TALX printout
     B. FTC with Employment
                                                                 NOI                                                                                       Web Coins/WMS
                                                                 Employability Plan                                                                        NYCWAY/HRA Viewer
                                                                 Notification of Temporary Assistance Work Requirements Determination                      POS/HRA Viewer
                                                                 (LDSS-4005)                                                                               NYCWAY
          FTR/FTC Job Search/Back-to-Work Vendor                 Assignment Information Summary (W-500G)                                                   NYCWAY
                                                                 Activity Inquiry screen,                                                                  NYCWAY (100A)/POS/HRA Viewer
                                                                 Case notes/W-25                                                                           NYCWAY
                                                                 Conciliation Notification (W-532A, W-532B, W-532C)                                        NYCWAY
                                                                 Assignment Inquiry screen, Attendance/Payment Inquiry Screen
                           Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 2)                                                                                                                                                     Human Resources Administration
Rev. 7/16/07                                                                                                                                                           Family Independence Administration
                                          Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                     For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                          The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.
                           Issue                                        Document(s) Required                                          Source(s)
     Public Assistance Cases
     Budget Reductions
     A. FTR/FTC Office of Child Support                        Appointment Notice                                                                        NYCWAY
        Enforcement (OCSE)                                     Activity Inquiry screen, case notes                                                       NYCWAY
     Case Management
     Closings
     A. Face-to-Face Recertifications
                                                               NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC)                                Web Coins/WMS/HRA Viewer/POS
                                                               Notice of Recertification Appointment (W-908T)                                            POS/HRA Viewer
          1.   FTR                                             All Change Actions Screen (NQCS6A)                                                        WMS
                                                               Rescheduled FFR (W-908CC)                                                                 NYCWAY/HRA Viewe
                                                               Activity Inquiry Screen, case notes/W-25
                                                               NOI (CNS), Recertification Application (LDSS-3174)                                        Web Coins/WMS/HRA Viewer
                                                               FFR Deferral Appointment Letter (W-113K, W-908VV)                                         POS/HRA Viewer/NYCWAY
                                                               Notice to Report to Job Center (M-3g)                                                     POS/HRA Viewer/NYCWAY
          2.   FTC
                                                               All Change Actions Screen (NQCS6A)                                                        POS/HRA Viewer
                                                               Activity Inquiry screen, FTR/FTC, case notes/W-25                                         WMS
                                                                                                                                                         NYCWAY (100A) HRA Viewer
                                                               NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC,                                Web Coins/WMS/POS/HRA Viewer
                                                               LDSS-4015A NYC, LDSS-4015B NYC)
                                                               Undelivered mail (envelope available)                                                     NYCWAY/Director's Office
     B. Whereabouts Unknown                                    Activity Inquiry screen                                                                   NYCWAY
                                                               Address History screens (1 and 6)                                                         WMS
                                                               FFR (one [1] year or less)                                                                POS/HRA Viewer
                                                               Benefits Issuance screen (to show benefits not redeemed)                                  WMS
                                                               NOI (CNS)                                                                                 Web Coins/WMS
                                                               Supplemental Security Income (SSI [SDX Screen])                                           WMS/HRA Viewer
                                                               Social Security Administration (SSA [RFI Screen])                                         WMS/HRA Viewer
                                                               Unemployment Insurance Benefit (UIB [RFI Screen])                                         WMS/HRA Viewer
     C. Unearned Income
                                                               FFR (one [1] year or less)                                                                HRA Viewer
                                                               Computer match/Income Clearance Program (ICP)/Resource File                               WMS/HRA Viewer
                                                               Integration (RFI), SSI/SSD/UIB award letter or printout                                   WMS
                                                               Budget (saved and current)
          Cost of Living Allowance (COLA) Increase             NOI to Change Benefits: NYC PA COLA (yearly proration notice)                             Web Coins/WMS
          (Yearly Mass Re-budgeting for SSI                    NOI to Reduce FS Benefits (COLA Increase [Mass] Notice)                                   HRA intranet
          Recipients)                                          SSI (SDX and RFI Screens)                                                                 WMS



                         Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 3)                                                                                                                                                      Human Resources Administration
Rev. 7/16/07                                                                                                                                                            Family Independence Administration
                                           Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                      For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                           The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.
                            Issue                                        Document(s) Required                                          Source(s)
     Public Assistance Cases
     Closings (continued)
                                                                NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC,                                Web Coins/WMS/POS/HRA Viewer
                                                                LDSS-4015A NYC, LDSS-4015B NYC)
                                                                FIA-3A/pay stubs                                                                          NYCWAY/HRA Viewer
                                                                Letter to Past/Present Employer (W-532) or documentation that W-532                       POS/HRA Viewer
                                                                mailed, verification from vendor (if applicable)
     D. Earned Income
                                                                Budget (saved and current)                                                                POS/WMS
                                                                FFR (one [1] year or less)                                                                POS/HRA Viewer
                                                                Computer match                                                                            WMS/HRA Viewer
                                                                Declaration of Employment (W-575T)                                                        POS/HRA Viewer
                                                                TALX printout
                                                                Client Request Control Card (W-111F)                                                      POS/HRA Viewer
                                                                Request for Additional Allowance or a Change in Grant (W-137A)                            POS/HRA Viewer
     E. Client's Request for Additional Allowance
                                                                Action Taken on Your Request For Emergency Assistance or Additional                       POS/HRA Viewer
                                                                Assistance (Participants Only) (W-137B)
     F.   WeCARE
                                                                NOI (CNS)                                                                                 Web Coins/WMS
          2    FTR WeCARE Initial/Return
                                                                Medical Provider Appointment (W-538C)                                                     HRA Viewer( WeCare Medical Report)
               Appointment
                                                                Activity Inquiry screen                                                                   NYCWAY
                                                                NOI (CNS)                                                                                 Web Coins/WMS
                                                                Activity Inquiry screen                                                                   NYCWAY
          2    FTC WeCARE Wellness Rehabilitation               Employability Plan                                                                        NYCWAY/HRA Viewer
               Plan                                             WeCARE Wellness Plan, specific information of noncompliance                               HRA Viewer (WeCare Medical Report)
                                                                WeCARE Medical Report (signed acknowledgement/goals)                                      HRA Viewer (WeCare Medical Report)
                                                                Notice of Termination                                                                     HRA Viewer
                                                                Finger Imaging Notice (W-519)                                                             POS/HRA Viewer
                                                                Finger Imaging Report Routing Slip (W-519C) and attachments                               POS/HRA Viewer
     G. Finger Imaging
                                                                Notice of Intent to Reduce or Discontinue Benefits (LDSS-4015 NYC,                        POS/HRA Viewer
                                                                LDSS-4016 NYC)
     H. Excess Income/Resources                                 WMS External Clearance Report/budget (saved and current)                                  POS/WMS
                                                                Computer match, NADA book value, life insurance policies                                  POS/WMS/HRA Viewer
          (unreported by participant; appearing on a            Pay stubs/award letters/titles/loans and stock information                                POS/HRA Viewer
          computer match)                                       Other documentation of earned/unearned income or resources                                POS/HRA Viewer




                          Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 4)                                                                                                                                                    Human Resources Administration
Rev. 7/16/07                                                                                                                                                          Family Independence Administration
                                         Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                    For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                         The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.

                        Issue                                                             Document(s) Required                                                            Source(s)
     Public Assistance Cases
     Reductions/Sanctions
                                                              NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC,                               Web Coins/WMS/POS/HRA Viewer
                                                              LDSS-4015A NYC, LDSS-4015B NYC)
                                                              FIA-3A/pay stubs                                                                         NYCWAY/HRA Viewer
                                                              Letter to Past/Present Employer (W-532) or documentation the W-532                       POS/HRA Viewer
     A. Earned Income                                         was mailed, verification from vendor (if applicable)
                                                              WMS budget (saved and current)                                                           WMS
                                                              FFR (one [1] year or less)                                                               POS/HRA Viewer
                                                              Computer match/ICP/RFI                                                                   WMS/HRA Viewer
                                                              TALX printout
                                                              NOI (CNS)                                                                                Web Coins/WMS
                                                              SSI award letter                                                                         WMS/HRA Viewer
                                                              SSA/RSDI (RFI or award letter)                                                           WMS/HRA Viewer
     B. Unearned Income
                                                              UIB award letter                                                                         WMS/HRA Viewer
                                                              FFR (one [1] year or less)                                                               POS/HRA Viewer
                                                              Budget (saved and current)                                                               WMS




                        Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 5)                                                                                                                                                      Human Resources Administration
Rev. 7/16/07                                                                                                                                                            Family Independence Administration
                                           Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                     For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                          The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.
                           Issue                                        Document(s) Required                                         Source(s)
     Public Assistance Cases
     Infractions                                                 (Infraction dates must be consistent across all Agency documents)
                                                                 Notification of Temporary Assistance Work Requirements                                  NYCWAY
     A. Contesting Employability                                 Determination (LDSS-4005)                                                               NYCWAY/HRA Viewer
                                                                 Employability Plan                                                                      NYCWAY
                                                                 Activity Inquiry screen
         1.   Medical Exemption                                  WeCARE Medical report                                                                   POS/HRA Viewer
         2.   School/Training                                    FIA School/Training Enrollment Letter (W-700D)                                          POS/HRA Viewer
         3.   Needed at Home                                     Family Care Assessment (W-582A)                                                         POS/HRA Viewer
                                                                 Proof of child's school attendance or Department of Education                           HRA Viewer
                                                                 registration for home schooling
     B. POISED
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Appointment letter                                                                      NYCWAY
              1. FTR – Call-In Appointment                       Activity Inquiry screen                                                                 NYCWAY
                                                                 Case notes/W-25                                                                         NYCWAY (100A)/POS/HRA Viewer
                                                                 Conciliation Notification (W-532A, W-532B, W-532C)                                      NYCWAY
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Referral                                                                                NYCWAY/HRA Viewer
                                                                 Activity Inquiry Screen                                                                 NYCWAY
                                                                 Case notes/W-25                                                                         NYCWAY (100A)/POS/HRA Viewer
              2    FTC                                           Attendance roster                                                                       HRA Viewer/POISED Liaison
                                                                 Termination roster                                                                      HRA Viewer
                                                                 Conciliation Notification (W-532A, W-532B, W-532C)                                      NYCWAY
                                                                 Assignment Inquiry screen                                                               NYCWAY
                                                                 Attendance/Payment Inquiry screens                                                      NYCWAY
     C. SASC
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Appointment letter                                                                      POS/HRA Viewer/NYCWAY
              1. FTR Initial Appointment                         Activity Inquiry screen                                                                 NYCWAY
                                                                 Case notes/W-25                                                                         NYCWAY (100A)/POS/HRA Viewer
                                                                 Address history                                                                         HRA Viewer
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Activity Inquiry screen                                                                 NYCWAY
                                                                 Case notes/W-25                                                                         NYCWAY (100A)/POS/HRA Viewer
              2    FTR Program
                                                                 Referral to program                                                                     HRA Viewer/NYCWAY
                                                                 Work Assessment form                                                                    HRA Viewer
                                                                 Participant's Rights and Responsibilities (M-75r)                                       HRA Viewer

                          Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 6)                                                                                                                                                      Human Resources Administration
Rev. 7/16/07                                                                                                                                                            Family Independence Administration
                                           Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                     For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                          The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.
                           Issue                                        Document(s) Required                                         Source(s)
     Public Assistance Cases
     Infractions (continued)
     C. SASC (continued)
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Case notes/W-25                                                                         NYCWAY
                                                                 Referral to program                                                                     NYCWAY (100A)/POS/HRA Viewer
                                                                 Participant’s Rights and Responsibilities (M-75r)                                       NYCWAY/HRA Viewer
              3.   FTC Outpatient Program
                                                                 Work Assessment form                                                                    HRA Viewer
                                                                 Activity Inquiry screen                                                                 HRA Viewer
                                                                 Assignment Inquiry                                                                      NYCWAY
                                                                 Site Inquiry                                                                            NYCWAY
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Activity Inquiry screen                                                                 NYCWAY
                                                                 Case notes/W-25                                                                         NYCWAY (100A)/POS/HRA Viewer
              4.   FTR CASAC
                                                                 Referral to Residential Treatment Program                                               NYCWAY/HRA Viewer
                                                                 Participant's Rights and Responsibilities (M-75r)                                       HRA Viewer
                                                                 Work Assessment form                                                                    HRA Viewer
     D. RTSC – Center 52
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Activity Inquiry screen/FTR/FTC                                                         NYCWAY
                                                                 Case notes/W-25                                                                         NYCWAY (100A) POS/HRA Viewer
              1.   FTC CASAC
                                                                 Referral to Residential Treatment Program                                               HRA Viewer
                                                                 Participant's Rights and Responsibilities (M-75r)                                       HRA Viewer
                                                                 Work Assessment form                                                                    HRA Viewer
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Notice of Recertification Appointment (W-908T)                                          POS/NYCWAY
              2.   FTR Face-to-Face Recertification
                                                                 Activity Inquiry screen                                                                 NYCWAY
                                                                 Address history                                                                         WMS
                                                                 NOI (CNS)                                                                               Web Coins/WMS
                                                                 Activity Inquiry screen/FTR/FTC                                                         NYCWAY
                                                                 Case notes/W-25                                                                         NYCWAY (100A)/POS/HRA Viewer
                                                                 Referral to Residential Treatment Program                                               HRA Viewer
              3.   FTC-Mandated Residential
                                                                 Participant's Rights and Responsibilities (M-75r)                                       HRA Viewer
                   Treatment Program (RTP)
                                                                 Work Assessment form                                                                    HRA Viewer
                                                                 Address History screen (NQCS15)                                                         WMS
                                                                 Site Inquiry screen                                                                     NYCWAY
                                                                 Assignment Inquiry screen                                                               NYCWAY




                          Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 7)                                                                                                                                                       Human Resources Administration
Rev. 7/16/07                                                                                                                                                             Family Independence Administration
                                            Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                       For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                            The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.

                             Issue                                                             Document(s) Required                                                           Source(s)
     Public Assistance Cases
     Infractions (continued)
     D. RTSC – Center 52 (continued)
                                                                    NOI (CNS or Manual Notice- LDSS-4014A NYC, LDSS-4014B NYC,                             WebCoins/WMS/POS/HRA/Viewer
                                                                    LDSS-4015A NYC, LDSS-4015B NYC)
                                                                    FIA-3A/pay stubs                                                                       NYCWAY/HRA Viewer
                                                                    Letter to Past/Present Employer (W-532)                                                POS/HRA Viewer
               4.   Earned Income                                   Budget (saved and current)                                                             POS/WMS
                                                                    FFR (one [1] year or less)                                                             POS/HRA Viewer
                                                                    Computer match/RFI                                                                     WMS/HRA Viewer
                                                                    Declaration of Employment (W-575T)                                                     POS/HRA Viewer
                                                                    TALX printout
                                                                    Activity Inquiry screen/FTR/FTC                                                        NYCWAY
               5.   Inadequacy – Personal Needs                     Assignment Inquiry screen                                                              NYCWAY
                    Allowance                                       Site Inquiry screen                                                                    NYCWAY
                                                                    Administrative Directive 91 ADM-44                                                     Intranet-NYS Human Services
                                                                                          Required for All Recoupments
                                                                    NOI                                                                                    Center Files/WMS
                                                                    Recoupment history/recoupment detail                                                   Center Files/HRA Viewer
     E. Recoupment                                                  Recoupment summary                                                                     WMS
                                                                    Benefits issued (current/archived)                                                     WMS
                                                                    Budget (saved/current)                                                                 WMS
                                                                                                                                                           WMS
                                                                    FFR (one [1] year or less)                                                             POS/HRA Viewer
         1.    Overpayment (agency error)
                                                                    Employer information                                                                   HRA Viewer
               • Agency issued benefits after closing,
                                                                    ICP packet (cintrak sheet)                                                             Center Files/HRA Viewer
                 income reported
                                                                    FIA-3A/pay stubs                                                                       NYCWAY/HRA Viewer
               • Agency failed to budget
                                                                    Client acknowledgement of change in budget                                             Center Files/HRA Viewer
                                                                    Computer Match Report                                                                  Center Files/HRA Viewer
                                                                    Pay stubs                                                                              POS/HRA Viewer
                                                                    Statewide Common Application (LDSS-2921) or TALX printout                              POS/HRA Viewer
          2.   Concealed Income                                     FFR (one [1] year or less)                                                             POS/HRA Viewer
                                                                    RFI screens                                                                            WMS
                                                                    Activity Inquiry screen                                                                POS/HRA Viewer/NYCWAY
                                                                    Case notes/W-25                                                                        NYCWAY (100A)/POS/HRA Viewer
          3.   Contested Recoupment                                 Fair Hearing decision                                                                  Web Coins
               (recoupment of aid to continue)                      Date of infraction                                                                     FHIS (Fair Hearing Information System)



                           Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 8)                                                                                                                                                       Human Resources Administration
Rev. 7/16/07                                                                                                                                                             Family Independence Administration
                                            Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                      For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                           The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.

                             Issue                                                            Document(s) Required                                                           Source(s)
     Public Assistance Cases
     Infractions (continued)
     E. Recoupment (continued)
                                                                    W-137A, W-137B, W-147X                                                                POS/HRA Viewer
                                                                    Utility shut-off notice, breakdown of rent arrears                                    HRA Viewer
          4.   Utility
                                                                    Agreement to Repay (M-858 series)                                                     HRA Viewer/POS
                                                                    Restriction screen (24)                                                               WMS
                                                                    Request for Emergency Assistance for an Active PA case (W-137A,                       POS/HRA Viewer
                                                                    W-137B)                                                                               POS/HRA Viewer
                                                                    Request for Advance Payment to Prevent Eviction (W-637B)                              HRA Viewer
          5.   Shelter Duplication
                                                                    Dispossess: 72-hour eviction notice                                                   HRA Viewer
                                                                    Landlord letter with breakdown of rent arrears                                        WMS
                                                                    Stale-dated checks                                                                    POS/HRA Viewer
     F.   Separate Food Stamps Determination
                                                                    Statewide Common Application (LDSS-2921)                                              POS/HRA Viewer
                                                                    Notification of Application Withdrawal (M-3mm)                                        POS/HRA Viewer
               C. Applicant Withdrawal                              Action Taken on Your Food Stamp Case (LDSS-3152)                                      POS/HRA Viewer

                                                                                                                                                          POS/HRA Viewer
                                                                    Action Taken on Your Application (LDSS-4013A NYC, LDSS-4013B                          POS/HRA Viewer
                                                                    NYC)
                                                                    Control of Assignments/Referrals Card (W-708)                                         POS/HRA Viewer
               D. Ineligible for Public Assistance
                                                                    Action Taken on Your Food Stamp Case (LDSS-3152)                                      POS/HRA Viewer
                                                                    Budget Entry Supervisory Summary Report (WINR0027)                                    POS/HRA Viewer
                                                                                                                                                          POS/WMS




                           Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 9)                                                                                                                                                         Human Resources Administration
Rev. 7/16/07                                                                                                                                                               Family Independence Administration
                                              Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                        For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                             The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.

                               Issue                                                            Document(s) Required                                                           Source(s)
Public Assistance Cases (continued)
Other Issues
Inadequacy
     A. General Inadequacy
                                                                      FFR one (1) year or less (burden of proof is on client)                               POS/HRA Viewer
                                                                      Statewide Common Application (LDSS-2921) (one [1] year or less)                       POS/HRA Viewer
         1.     Failure to Add Household Member                       W-137A, W-137B                                                                        POS/HRA Viewer
                                                                      PA and FS budget calculations                                                         WMS
                                                                      Relevant benefits screens                                                             WMS
                                                                      Written statement indicating changes in the household                                 HRA Viewer
         2.     Failure to Remove Household Member
                                                                      W-137A, W-137B                                                                        POS/HRA Viewer
                                                                               (Documents required for all Special Inadequacies)
                                                                      Request for Additional Allowance or a Change in Grant (W-137A)                        POS/HRA Viewer
                                                                      Notice of Acceptance/Denial (W-137B)                                                  POS/HRA Viewer
     B. Inadequacy of Special Grants                                  LDSS-4013A NYC, LDSS-4013B NYC                                                        POS/HRA Viewer
                                                                      FFR (one [1] year or less)                                                            POS/HRA Viewer
                                                                      Case notes/W-25                                                                       NYCWAY (100A)/POS/HRA Viewer
                                                                      Client Request Control Card (W-111F)                                                  POS/HRA Viewer
                                                                      Statewide Common Application (LDSS-2921)
         1.   Pregnancy Allowance                                     Doctor's verification of pregnancy (EDC letter)                                       POS/HRA Viewer
                                                                      Letter from shelter (no cooking facilities)                                           POS/HRA Viewer
         2.   Restaurant Allowance
                                                                      Letter from landlord (inoperable stove, refrigerator, etc.)                           POS/HRA Viewer
                                                                      Three (3) estimates, bill from storage company, Benefit Issuance                      POS/HRA Viewer
         3.   Storage
                                                                      Printout
         4.   Broker's Fee                                            Lease, letter from broker                                                             POS/HRA Viewer
         5.   Furniture Allowance                                     Fire/natural disaster, shelter verification                                           POS/HRA Viewer
                                                                      Natural disaster data                                                                 POS/HRA Viewer
         6.   Clothing Allowance
                                                                      (letter from Red Cross/fire department)




                             Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 10)                                                                                                                                                     Human Resources Administration
Rev. 7/16/07                                                                                                                                                            Family Independence Administration
                                           Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                     For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                          The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.
                        Issue                                            Document(s) Required                                          Source(s)
 Non-Public Assistance Food Stamp Cases
                                                                Notice of Intent to change Food Stamps Benefits (Timely and Adequate)                        Case Files/HRA Viewer/Web Coins
                                                                (LDSS-3620 NYC). Notice of Intent to change Food Stamp Benefits
     •    FTR/FTC Face-to-Face Recertification                  (Adequate Only) (LDSS-3621) or CNS notice (closing or reduction only)                        Case Files/HRA Viewer
     •    Excess or Increased Income/Resources                  Food Stamp Change Report Form (LDSS-3151)                                                    Case Files/WMS
     •    Decreased Needs                                       FS Budget Calculation (WINR0153)                                                             HRA Viewer/NYCWAY
     •    Adequacy Issues                                       Budget Entry Supervisor Summary Report (WINR0027)                                            Case Files/WMS
                                                                Turnaround Document (TAD) (LDSS-3517)                                                        Case Files/WMS
     •    Failure to Provide Verification                       FS Recoupment – Suffix Summary (NQCS9R)                                                      Case Files/WMS
                                                                Food Stamp Issuance Screen Printout (NQCS5C)
                                                                Appointment letter                                                                           HRA Viewer
                                                                Annotated (WINR076)                                                                          Center Files/HRA Viewer
                                                                CNS Notice                                                                                   WebCoins
                                                                Notice of Outstanding Required Documentation (W-120D)                                        Case Files/HRA Viewer
          1.    FTC/FTR Face-to-Face Recertification
                                                                Documentation Requirements and/or Assessment Follow-Up (W-113K)                              Case Files/HRA Viewer
                                                                LDSS-3152                                                                                    Case Files/HRA Viewer
                                                                W-25                                                                                         Case Files/HRA Viewer
                                                                Documentation Receipt (EXP-76R)                                                              Case Files/HRA Viewer




                          Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.
Form W-206C (page 11)                                                                                                                                                      Human Resources Administration
Rev. 7/16/07                                                                                                                                                             Family Independence Administration
                                            Conference and Fair Hearing Evidence Packet Preparation Desk Aid
                                      For conferences, relevant WMS Screens (22, 04, 03, 01, 06, Budget) must be reviewed.
                           The issues and documents presented do not comprise an exhaustive list, but are the most frequently presented.
                                                                 Food Stamps Benefits Application/Recertification (LDSS-4826), Action                         Case Files/HRA Viewer/WebCoins
                                                                 Taken on your FS case (LDSS-3152)
                                                                 Pay stubs, Letter to Past and Present Employer (W-532)                                       Case Files/HRA Viewer
                                                                 Bank statements, award letters                                                               Case Files/HRA Viewer
                                                                 Budget Entry Supervisory Summary Report (WINR0027)                                           Case Files/WMS
                                                                 Food Stamp Budget Calculation WINR0153 (For NPA and NPA-SSI                                  Case Files/WMS
          2.    Excess or Increased Income/Resources
                                                                 Cases)                                                                                       Case Files/HRA Viewer
                                                                 Notice of Intent to Change Food Stamp Benefits (LDSS-3620),                                  Case Files/HRA Viewer
                                                                 Shortened Food Stamp Application (LDSS-3621)                                                 Case Files/WMS
                                                                 W-25
                                                                 Food Stamp Recertification History Sheet (W-132X)
                                                                 TALX Printout (Where Applicable)
                                                                 LDSS-4826                                                                                    Case Files/HRA Viewer/WebCoins
                                                                 LDSS-3620 NYC                                                                                Case Files/HRA Viewer
                                                                 LDSS-3621 NYC                                                                                Case Files/HRA Viewer
          3.    Decreased Needs
                                                                 WINR0027, WINR0153                                                                           Case Files/HRA Viewer
                                                                 Food Stamp Eligibility Determination History Sheet (W-132A)
                                                                 Food Stamp Recertification History Sheet ( W-132X)
                                                                 LDSS-4826, CNS                                                                               Case Files/HRA Viewer/WebCoins
                                                                 Pay stub, W-532                                                                              Case Files/HRA Viewer
          4.    Adequacy Issues                                  W-132A, W-132X                                                                               Case Files/HRA Viewer
                                                                 Award letters                                                                                Case Files/WMS
                                                                 WINR0027, WINR0153                                                                           Case Files/WMS
                                                                 LDSS-4826, LDSS-3152, CNS                                                                    Case Files/HRA Viewer/WebCoins
                                                                 Notice of Outstanding Required Documentation (W-120D)                                        Case Files/HRA Viewer
          5.    Failure to Provide Verification
                                                                 EXP-76R                                                                                      Case Files/HRA Viewer
                                                                 History Sheet (W-25)                                                                         Case Files/HRA Viewer




                           Note: The infraction date on the NOI must be consistent with the appointment date. If not, the Agency is required to resolve the Fair Hearing issue.

				
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