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BAM 300 11 of 14 THE CASE RECORD BPB 2026-016 7-1-2026

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

DHS-4358-A, Notice of Overissuance.

DHS-4358-B, Agency and Client Error Information and Repay Agreement.

DHS-4358-C, Overissuance Summary.

DHS-4358-D, Hearing Request for Overissuance or Recoupment Action.

DHS-4701, Overissuance Referral.

Plain paper with the OI calculation, if needed.

OI-related hearing decision, withdrawal or note that the client failed to show for the hearing.

OI-related correspondence and other documents

Debt collection hearing decision and related documents. Do not obsolete overissuance documents until four years after the overissuance event is paid off or written off. Note: Documentation listed above generated by the recoupment specialist or designed staff person must be forwarded to the case record as soon as administratively possible. • Underissuance:

DHS-13, Supplemental Payment Authorization.

DHS-521, Notice of Restoration Letter.

DHS-1172s, FIP/SDA Worksheet, or LOA Worksheet, showing the underissuance.

DHS-2242s, Food Assistance Program Worksheet, or LOA FAP Worksheet, showing the underissuance.

DHS-3925, Restoration of Lost Food Stamp Benefit, or LOA OI/UI Summary.

Plain paper with the underissuance calculation, if needed.

Correspondence and other documents related to the supplementation. At local office option, underissuance materials may be placed in the obsolete packet after the client supplement is issued.