Form H1825, Entitlement to Restored Benefits

Instructions

Updated: 5/2007

Purpose

• To provide a written notice to food stamp and TANF households when they are entitled to restored benefits.
• To explain how restored benefits will be provided.
• To explain to households that they may request a fair hearing if they are dissatisfied with the benefits.
• To provide notice to the hearing officer that an appeal decision has been carried out.

Procedure

When to Prepare

Advisors prepare Form H1825 any time a household is determined to be entitled to retroactive benefits or a refund.

Number of Copies

Advisors prepare an original and one copy of Form H1825, except when restoration of benefits is authorized by a hearing officer in a fair hearing. In this case, a third copy is required.

Transmittal

Give or mail the original to the client and file the duplicate in the Claims/Restored Benefits section of the case record. When a third copy is required, send it to the hearing officer who authorized the restored benefits.

Form Retention

Keep the case record copy for three years from the month the form is dated.

Detailed Instructions

In the window space at the top of the letter, enter the client's name and mailing address. (Form H1825 is designed for mailing in a number 10 window envelope.)

In the box at the upper right, enter the date Form H1825 was completed, food stamp and/or TANF case number(s) and name of the advisor or responsible staff.

Office Address, Area Code and Telephone Number — In the space provided, stamp the office address and telephone number. This information must be legible.

The benefits are in the amount of: — Enter the dollar amount of the entitlement.

The benefits will be provided to you in the form of: — Check the appropriate box to indicate how the benefits will be provided.