This SHMTL contains ten internal forms that are newly created or revised for accuracy and compatibility with the new Hearings and Appeals Tracking System (HATS X). The effective date of the forms is January 2015, and the forms are being released in conjunction with the launch of HATS X.

JFS 04007 "Administrative Disqualification Hearing Decision," effective 09/1994 is obsolete and replaced by JFS 04007"Administrative Disqualification Hearing Decision," effective 01/2015. This revised, internal form is created for accuracy and compatibility with the new HATS X system. It is the decision resulting from an administrative disqualification hearing being requested and subsequently conducted. The form notifies the accused whether or not he/she has been disqualified as a result of committing an intentional program violation.

JFS 04026"Waiver of Administrative Disqualification Hearing," effective 05/2001, is obsolete and replaced by "Waiver of Administrative Disqualification Hearing," effective 01/2015. It provides a customer accused of an intentional program violation to waive his/her right to an administrative disqualification hearing. The form describes the alleged acts of intentional program violation, a summary of the evidence supporting the allegation, and the penalties that would be imposed as a result of waiving the hearing.

JFS 04027 "Disqualification Consent Agreement," effective 05/2002, is obsolete and replaced by JFS 04027"Disqualification Consent Agreement," effective 01/2015. This revised, internal form is created for accuracy and compatibility with the new HATS X system. It provides a customer accused of an intentional program violation the opportunity to reach a disqualification agreement, foregoing the administrative disqualification hearing. The form describes the penalty that will be imposed and its effects (if any) on other members of the household.

JFS 04044"Intentional Program Violation Dismissal Notice," effective 01/2015 is a new, internal-use only form created for accuracy and compatibility with the new HATS X system. It notifies the county that the intentional program violation referral was rejected as incomplete. The form details the requirements that must be met to initiate an administrative disqualification hearing and specifies which of the requirements the county failed to meet.

JFS 04058 "Explanation of Administrative Disqualification Hearing Procedures," effective 05/2002, is obsolete and replaced by JFS 04058"Explanation of Administrative Disqualification Hearing Procedures," effective 01/2015. This is a revised, internal form created for accuracy and compatibility with the new HATS X system. It describes the process of an administrative disqualification hearing, as well as information relating to the right and responsibilities of the accused.

JFS 04059 "Explanation of State Hearing Procedures," effective 10/2008, is obsolete and replaced by JFS 04059"Explanation of State Hearing Procedures," "Waiver of Administrative Disqualification Hearing," effective 01/2015. This is a revised, internal form created for accuracy and compatibility with the new HATS X system. It describes the process of a state hearing, as well as information relating to subpoenas and compliance.

JFS 04060 "Referral for Administrative Disqualification Hearing," effective 05/2001, is obsolete and replaced by JFS 04060"Referral for Administrative Disqualification Hearing," effective 01/2015. This revised, internal form is created for accuracy and compatibility with the new HATS X system. It is used by counties to refer a suspected case of an intentional program violation to BSH for an administrative disqualification hearing. The form details relevant demographic information, a description of the acts of intentional program violation alleged, and the evidence supporting the allegation.

JFS 04061 "Notice of Administrative Disqualification Hearing," effective 06/2001 is obsolete and replaced by JFS 04061"Notice to Appear for an Administrative Disqualification Hearing," effective 01/2015. This revised internal, form created for accuracy and compatibility with the new HATS X system. It notifies the customer that he/she has been accused by the county of committing an intentional program violation and that an administrative disqualification hearing has been scheduled as a result. The form provides the date, time, and location of the hearing, as well as the rights and responsibilities stemming from the procedure.

JFS 04062 "Notice of Disqualification for Intentional Program Violation," effective 05/2001 is obsolete and replaced by JFS 04062"Notice of Disqualification for Intentional Program Violation," effective 01/2015. This revised, internal form is created for accuracy and compatibility with the new HATS X system. It notifies a customer that he/she has been disqualified because of having committed an intentional program violation. The form indicates the program area(s), duration, and amount of overpayment determined because of the administrative disqualification hearing.

JFS 04064"Notice to Appellant," effective 01/2014 is a new, supplemental form describing the appellant's rights once a hearing decision, administrative appeal decision, dismissal, or intentional program violation decision is rendered. The form provides dates and information regarding the state hearing process and subsequent appeal rights. Instructions:

This information is also available on the Internet and may be accessed at:

ODJFS Electronic Manuals:http://emanuals.jfs.ohio.gov/

InnerWeb Calendar:http://www.odjfs.state.oh.us/lpc/calendar/staff/

Internet Calendar:http://www.odjfs.state.oh.us/lpc/calendar/