SHMTL 40 (State Hearings – Updated Forms)
State Hearings Manual Transmittal Letter No. 40
July 22, 2019
TO: All State Hearings Manual Holders
FROM: Kimberly Hall, Director
SUBJECT: State Hearings – Updated Forms

This SHMTL contains one internal form that is revised for accuracy and compatibility with existing computer systems.  The effective date of the form is July 2019.  Additionally, one form has been obsoleted and not replaced.

JFS Form 04067, “APPEAL SUMMARY,” effective 05/2001 is obsolete and replaced by JFS 04067, “APPEAL SUMMARY,” Effective 07/2019. This revised form removes outdated references to assistance group name and assistance group case number and food stamps. The updated form utilizes language which is consistent with current technology.

JFS Form 04085, “PRIOR NOTICE OF RIGHT TO A STATE HEARING,” effective 2/2014 is obsolete and is not being replaced. All of the information contained on this form is reflected on the recently revised JFS Form 04065. Users are asked to utilize the JFS Form 04065 and discontinue use of the JFS Form 04085.


LOCATION Remove Insert
FORMS JFS 04067 (effective 5/2001) JFS 04067 (effective 7/2019)
  JFS 04085 (effective 2/2014) Do not replace

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