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West Virginia Income Maintenance Manual Chapter 9

West Virginia Income Maintenance Manual Page 35 Chapter 9 Client Notification

WEST VIRGINIA DEPARTMENT OF HUMAN SERVICES (WV DOHS) PRE-HEARING CONFERENCE AND/OR FAIR HEARING REQUEST FORM

If you disagree with the decision made on your application or the proposed changes in your benefits, you may ask for a Pre-Hearing Conference, a Fair Hearing or both, either orally or in writing. You have the right to be assisted and/or represented by a person of your choice at the Pre-Hearing Conference/Fair Hearing. This person may be a friend, relative, attorney or any other person. A Pre-Hearing Conference is an informal meeting with you and any person(s) you choose to have with you, your West Virginia Department of Human Services (DOHS) Case Worker and the Supervisor. This meeting is to explain anything you have questions about and for you to explain your situation. This Conference may resolve the problem and eliminate the need for a Fair Hearing. If not, you may proceed with a Fair Hearing. A Fair Hearing is a meeting with you and anyone you choose to have with you, a State Hearings Officer, the DOHS representative and any witnesses you or the DOHS believes can provide appropriate evidence. The Fair Hearing process is designed to make sure the DOHS took the correct action on the issue(s) involved. If you ask for a Pre-Hearing Conference and/or a Fair Hearing, due to a decrease or closure of your benefits before the date of the proposed closure or reduction, your benefits will not be reduced or stopped, pending a final decision. Otherwise, the change will be made, and you may ask for a Fair Hearing or Pre-Hearing Conference within 90 days of the effective date of the actions. NOTE: If your benefits are being reduced or stopped due to a SNAP Review, a mass change (such as the annual Social Security increase) or because you signed a form giving up your right to receive advance notice of this change, your benefits will not be continued (even if you request it), but a hearing will be held. The DOHS Case Worker will help you make arrangements for transportation to a hearing if you cannot provide your own transportation and you so request. Your hearing may also be conducted by phone. Also, the Case Worker will help you prepare for the Fair Hearing, if you so request. To request assistance, call DOHS Client Services: 1-800-642-8589. If you wish to have a Pre-Hearing Conference and/or Fair Hearing, complete the section below and return your local DOHS Office. The address is on the top of the enclosed notice or can be provided to you by DOHS Client Services. You may review the materials in your case record during normal business hours (Monday-Friday, 8:30 a.m.-5:00 p.m.). If you request, we will send you a copy of the applicable Family Assistance Manual section or you may view and print the manual sections yourself on the internet at https://DoHS.wv.gov/bcf/Pages/default.aspx.

I would like to have a Pre-Hearing Conference with my Worker and/or the Supervisor. (You may have a Conference before the Fair Hearing and then proceed with the Fair Hearing if you are not satisfied.) I want a Fair Hearing before a State Hearings Officer. (You may have a Fair Hearing without a Pre- Hearing Conference.) I wish to have my Fair Hearing by phone. Please send me the Family Assistance Manual section on which the decision was based. I do NOT wish to continue receiving benefits while pending a Pre-Hearing Conference or a Fair Hearing decision. If the DOHS’s decision is not upheld at the Pre-Hearing Conference or Fair Hearing, DOHS will pay you any benefits you missed during the Pre-Hearing Conference/Fair Hearing process. Signature: Date: