SFN 1940, TANF/SNAP Notice of Suspected Intentional Program Violation 400-19-165-130

(Revised 6/1/10 ML #3218)

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The SFN 1940 is intended to:

1. Notify an individual in writing when that individual is suspected of having committed intentional program violation;
2. Provide a means of waiving the right to a hearing if an individual suspected of intentional program violation wishes to waive their right to an administration disqualification hearing;
3. Assign a hearing time if the right to an administrative disqualification hearing is not waived; and
4. To allow an individual who desires that a hearing officer be present at the hearing, rather than having a telephone hearing, to indicate that desire.

 

Form completion instructions:

Pages 1 and 2 are to be completed by the county initiating the administrative disqualification hearing procedure. The form is to be signed in this section, by an Eligibility Worker, Supervisor, or County Director who will be present at the meeting with the individual suspected of having committed intentional program violation.

 

Page 3, the "waiver of hearing" section, , either A or item B, is to be signed if the individual wishes to waive their right to an administrative disqualification hearing.

 

Page 4, the individual suspected of intentional program violation must sign on this page if the individual does not waive their right to a hearing and desires that a hearing officer be present at the hearing, rather than a telephone hearing.

 

If an administrative disqualification hearing is scheduled, the Appeals Referee Supervisor will complete "notice of hearing" and so advise the suspected individual.

 

Form distribution:

• Original
• If it is decided at the time of the meeting that there was no intentional program violation - file original and all copies in casefile along with a notation of the results of the meeting.
• If the right to hearing is waived, or if there is to be a hearing - forward to Appeals Referee Supervisor.
• 1 Copy - If the right to a hearing is waived, or if there is to be a hearing - give to the accused individual signing the form.
• 1 Copy - Casefile.

 

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms. (80kb pdf)

 

E-Forms are presented in Adobe Acrobat and require the Adobe Acrobat reader.  If you do not currently have Adobe Acrobat reader installed, you may download a free copy by clicking the Get Adobe Reader icon below.