State Hearing Decision - Hearing Decisions

STATE HEARING DECISION CONTINUATION
Appellant’s Exhibits
1. State hearing request, 2 pages
2. Authorization to represent
3. Miscellaneous documents, 32 pages
Appendix
Agency’s Exhibits
A. Appeal summary
B. Statewide online computer system screen (CRISE) Update Fair Hearing Request
C. CRISE Notice History and Detail, 3 pages
D. CRISE Individual Demographics
E. CRISE Running Record Comments, 8 pages
F. Returned mail, 4 pages
G. Returned mail, 2 pages
H. Returned mail, 3 pages
I. Notice of Denial mailed January 10, 2012,7 pages
J. Statement from Appellant’s boyfriend dated December 23, 2011
K. JFS 07220 Verification Request Checklist dated December 13, 2011
L. Fax pages from Authorized Representative, 3 pages
M. CRISE Data Linkage Inquiry State Wage Information
N. JFS 07110 Retroactive Medicaid Worksheet, 2 pages
O. JFS 07216 Combined Programs Application dated stamped December 8, 2011
P. JFS 07200 Request for Cash, Food, and Medical Assistance dated stamped May 26, 2011, 4
pages
Q. Handwritten statement from Appellant dated October 5, 2011
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