FAA6.F Administrative : 03 Appeals - Overview
Appeals - Overview
(01/01/21 - 12/31/21)
An Appeal Hearing is a process through which a participant or representative may request a formal appeal hearing when they disagree with any action or decision taken by FAA. This can include, but is not limited to the following:
FAA's disposition timeliness
Results of the eligibility determination
EBT account retailer-initiated debit request
Denial of an EBT account credit request
See EBT Account Adjustments for additional information regarding EBT Account adjustments.
A participant or representative may ask for an appeal hearing on any decision, action or inaction, which may or may not affect the participation or benefits of the budgetary unit.
FAA may request an appeal on a ruling of an Administrative Law Judge (ALJ) when the agency disagrees with the decision. Appeals can be requested by FAA for all NA rulings (including IPVs). (See Appeals Filed by FAA)
An applicant or participant who wishes to appeal an action or inaction must make an oral or written request for a hearing to the Department.
For NA, the request must be made within 90 days of the notice date advising the applicant or recipient of the action being appealed. A recipient may appeal the current level of benefits at any time within a certification period. Action by the Department shall include a denial of a request for restoration of any benefits lost more than 90 days but less than one year before the request for a hearing.
For CA, the request must be made within 30 days of the notice date advising the applicant or recipient of the action being appealed.
Appeal hearing requests due to an EBT Account Adjustments debit must be filed within 15 calendar days from the date of the notice. When a debit is appealed within the 15 calendar days, the EBT account is not debited until an appeal decision is rendered.
NOTE There may be instances when the account is debited prior to notification of the appeal request. When this occurs, FIS credits the EBT account with the amount debited.
FAA has the initial burden of presenting the evidence to support the adverse action.
An appeal hearing may be requested by any of the following:
The Primary Informant (PI)
An authorized representative
An Attorney representing a hospital that is acting as an authorized representative for a hospitalized participant
Any responsible adult in the budgetary unit
NOTE Whenever possible FAA must attempt to resolve the participant's or representative’s questions or concerns about an eligibility decision prior to the participant submitting an appeal request.
An ALJ conducts the impartial third-party review of the eligibility determination.
FAA staff must not limit or interfere with the participant’s right to request a hearing. When requested, FAA staff are required to help the participant to complete the request.
NOTE When the reason for the request is unclear, ask the PI to clarify the reason for the request.
When the request is regarding a Pascua Yaqui or Hopi Tribal TANF determination, do not refer the appeal hearing request to the Appeals Processing Unit (APU), follow the procedures outlined below:
When a hearing is requested, the individual requesting the hearing, becomes known as an appellant(g), and is referred to as such throughout this section.
Policy and procedures regarding appeal hearings are outlined as follows:
All adverse action notices also contain hearing rights and procedures.