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Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
- To serve as notice to any client who has expressed a desire to appeal that the request for a fair hearing has been received by the department.
- To serve as a notice to the appellant of the time, date and place of the scheduled hearing.
- To serve as the cover letter to the appellant for Forms H4800, H4805 and H4806.
- To serve as notice to the program area so the program area can make a representative available for the hearing.
- In food stamp appeals involving an employment contractor, to serve as notice to the contractor of the time and date of the hearing so that the contractor may forward a copy of the appropriate material to the hearing officer and to ensure that the contractor will be able to make a representative available for the hearing.
- In TANF appeals involving an employment services noncompliance disqualification, to serve as a notice to the employment services worker of the time and date of the hearing so that the worker may forward a copy of the appropriate material to the Hearing Office to ensure that the employment services worker is available for the hearing.
When to Prepare
The hearing officer prepares Form H4803 in all appeals immediately upon receipt of Form H4800, Fair Hearing Request Summary.
Number of Copies
Staff type an original and four copies. Five copies are needed in the case of food stamp appeals involving an employment contractor, medical necessity or Preadmission Screening and Annual Resident Review (PASARR) determination.
The original is mailed to the appellant and includes the following:
- Envelope addressed to the hearing officer;
- Form H4805, Statement of Appellant's Rights in Hearing Proceedings;
- Form H4806, Request for Another Appointment; and
- Form H4800, Fair Hearing Request Summary.
An additional copy is prepared and sent to the appellant's authorized representative or legal counsel, if there is one.
Copies are sent to the supervisor and the worker or technician.
In food stamp cases involving an employment contractor, a copy is sent to the local office of the employment contractor (attention: Office Manager) as designated on Form H1816, Food Stamp E&T Noncompliance Report.
In TANF cases involving an employment services noncompliance disqualification, a copy is sent to the employment services worker designated on Form H2581, Choices Noncooperation Report.
In medical necessity or PASARR cases, send one copy to the facility.
A copy is retained by the hearing officer.
The hearing officer's copy is destroyed three years after the appeal is completed. The supervisor's copy may be retained for one year for worker evaluations, if needed. The case record copy is retained for three years after the case is closed.
Exception: For TANF, Food Stamps or CSS Medical Programs, see the retention requirements in the Texas Works Manager's Guide.
Date — Enter the date Form H4803 is prepared.
Appeal ID — Enter the Appeal ID number.
Appellant's Name and Address — Enter the name and mailing address of the client (please type).
Hearing Appointment (Day, Date, Time) — Enter the day of week, date and time of the scheduled hearing.
Hearing Officer Information — Enter the name, address, telephone number and fax number of the hearing officer.
For free legal assistance, contact: — Enter the name, address and telephone number, if available, of the free legal assistance closest to the appellant.