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IMA POLICY MANUAL
PART VIII: CASE MAINTENANCE
Chapter 7: Grievances and Fair Hearings
Introduction 7.1
| ALL |
An applicant/recipient dissatisfied with an action taken by DHS that affects benefits, program participation or program requirements may request a fair hearing The applicant/recipient may file a hearing request with any member of the department. He may also file a request with the Office of Administrative Hearings (OAH), the District agency that is responsible for adjudicating disputes regarding eligibility for department programs. Upon receiving a request from an applicant/recipient or his/her representative, a fair hearing shall be held within a reasonable time not to exceed 45 days.
When an applicant/recipient requests a fair hearing from a DHS representative, the request shall be forwarded to the Office of Administrative review and Appeals (OARA). Upon receiving the request for a hearing, OARA schedules an administrative conference and notifies OAH. OAH shall assign the case to an administrative law judge (ALJ) and set a date and time for the fair hearing. The purpose of the administrative review conference is to try to resolve the disagreement informally. If the administrative review conference resolves the issue, the applicant/recipient may sign a written request to withdraw the fair-hearing request. Participation in the administrative review conference is always optional Unless an applicant/recipient opts to participate in the administrative review conference and agrees to withdraw the request, the fair hearing will proceed as scheduled.
OAH holds hearings and renders decisions on disputes between applicants/recipients and the agency. OAH also provides a written final decision explaining its findings and ruling to the applicant/recipient, his representative and DHS/IMA. An applicant/recipient who is dissatisfied with the outcome of a fair hearing can appeal the final hearing decision to the DC Court of Appeals.
Written information regarding the right to request a hearing and the method of making such request shall be furnished to each public assistance applicant/recipient at the time of application and whenever DHS notifies the household that it intends to take action which may adversely affect benefits, including changes in or terminations of assistance payments. Such written notice shall include:
- that the applicant/recipient has the right to be represented by legal counsel or by a lay person who is not an employee of the District
- that she may bring witnesses on her behalf
- that reasonable expenses related to the hearing, such as transportation costs for the applicant/recipient and his witnesses will be paid by the department
- a list of public and private sources providing legal services at low or no cost.
IMA will monitor the implementation of all final decisions for IMA programs to ensure that it has complied with all final determinations.
Applicants/recipients may also report complaints about the quality of service provided by the agency. An applicant/recipient that has a complaint about DHS procedures or staff related to any IMA-administered programs may contact the Customer Service Unit, a supervisor, center manager or the Administrator or Deputy Administrator of the IMA. The FS program has a formalized mechanism for handling complaints related to the FS program (see Section 7.6: Federal Reporting Requirements for Compliance in this Chapter). OARA handles FS complaints and is required to submit annual reports on the number and type of complaints received. |
| Fair Hearings |
DCMR, Title 1, Chapter 28, 2800-2899
TANF: D.C. Official Code 4-210;
4-205.19h; 4-205.55; 4-
205.56, 4-205.57
GC: See TANF and D.C. Official Code 4-205.5a |
MA: 42 CFR 431.200 - .246
FS: 7 USC 2020(e)(10);7 CFR 273.15 |
Administrative Reviews 7.3
| ALL |
When an applicant or recipient requests a fair hearing, OARA schedules an administrative review conference which the applicant/recipient has the option of attending. The administrative review conference provides an informal forum for the Department and recipient to review the Department’s decision regarding benefits and, where appropriate, Department errors can be corrected. Applicants/recipients who choose not to attend an administrative conference or are dissatisfied with OARA’s decision in a dispute remain entitled to a fair hearing.
The OARA will:
- review contested agency determinations
- maintain records of all requests for fair hearings transmitted to OARA
- discuss pertinent laws and regulations with applicants/recipients (and their legal representative, if applicable) to clarify policy and legal issues once a fair hearing has been requested, and conduct administrative review conferences for all programs administered by IMA.
Any case alleging discrimination based on age, religion, sex, race, color, disability, national origin, political belief, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, source of income, or place of residence or business will be forwarded to the OIC.
Any complaint concerning collection of a Food Stamp debt through the Treasury Offset Program (TOP) will be referred to the Payments and Collections Division. Only delinquent Food Stamp claims are not subject to collection through TOP. These customers were previously given the opportunity to exercise their fair hearing rights when their Food Stamp claims were established. |
Guidelines for Reviews 7.3.1
| MA |
OARA will set a date for the administrative review conference. Administrative review conferences will be held not later than 20 days from the date the fair hearing request is received by DHS. (The fair hearing will be held not later than 45 days from the date of the request.) Notification of the administrative review conference will be made through ACEDS to the applicant/recipient and notice will also be sent to his/her representative, OAH and the appropriate center manager.
The written notice shall inform the applicant/recipient of the following:
- the time and place for the administrative review
- that the review will not be held if s/he does not attend
- that failure to attend will not affect the scheduled fair hearing which s/he has requested
- his/her right to review the case record
- the right to be represented by a person of his/her choosing, including legal counsel, as well as the availability of low or no cost legal services from public and private sources.
When appropriate, prior to the administrative conference, OARA shall:
- hold a discussion about the issues surrounding the case with the center manager or others who are knowledgeable about the case to determine if the administration's action or inaction was proper (If the action or inaction was not proper, the center manager shall be instructed to implement corrective action within three business days. If the corrective action is not completed in a timely manner, the IMA Administrator shall be notified of the inaction by OARA.)
- review the case record to ensure that it is properly documented and accurately reflects the determinations made by the SSR.
- request that the supervisor prepare a justification for action taken in relation to the contested facts or issues.
At the scheduled time, the administrative conference will be conducted and the applicant/recipient must be:
- informed of his right to review the case record
- advised that if the result of the review is not satisfactory to him the requested fair hearing will be held as scheduled
- informed that if she is satisfied with the result of the review, the request for a hearing may by withdrawn by signing a written statement of withdrawal.
After the administrative conference, written findings, conclusions and recommendations (Conference Summary and Determination) are prepared and sent simultaneously to the applicant/recipient, his representative, if any, the center manager and OAH.
If the applicant/recipient prevails, OARA shall instruct the center manager to implement corrective action within three business days. If the corrective action is not completed timely, the Administrator of IMA will be notified of the inaction by OARA.
| Ms. Hernandez applied for TANF for herself and her two children on June 4th. The SSR found them ineligible based on immigration status an sent a denial notice. Upon receiving the denial notice, Ms. Hernandez requested a fair hearing. She attended an administrative review conference and OARA found that she and her children were eligible based on their immigration status. On August 3, OARA sent the center manager the OARA determination By August 6, Ms. Hernandez's application must be re-opened, and her eligibility for TANF redetermined in accordance with OARA's instructions. |
If the applicant/recipient does not sign a statement of withdrawal, the fair hearing will proceed as scheduled.
If the applicant/recipient fails to appear at the scheduled conference or to contact the OARA, the appeals officer will send a Conference Summary and Determination letter to advise the applicant/recipient that the matter has been forwarded to OAH for resolution. Failure to attend the administrative conference will not impact the course or conduct of the scheduled fair hearing.
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| TANF |
See MA.
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| GC |
See MA. |
| FS |
See MA. In addition, the OARA will give priority to a request for review or a fair hearing in an expedited FS case. If an applicant/recipient requests expedited FS services and it is denied, the OARA shall schedule an agency conference within 2 days, unless the household requests that it be scheduled later or states that it does not wish to have a conference. |
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