Form H1970, ONA Case Review

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Effective Date: 1/2003


Word: H1970.doc

PDF: H1970.pdf


Updated: 10/1999


To serve as

  • the supervisor's means of notifying staff of the results of a case record review;
  • the eligibility worker's means of notifying the supervisor how the error was corrected.


When to Prepare

Use this form to record results of error findings during a case reading review.

Number of Copies

Original and one copy.


File the original in the case record. The case record is returned to the worker for correction. The worker corrects the error, completes the bottom section of the form, and returns the case record to the supervisor.

The copy is kept by the supervisor for analysis of case reading results.

Form Retention

Keep Form H1970 in the case record. The case record is kept for three years and then destroyed.

Detailed Instructions

First Section


Second Section

Purpose of Case Reading — Check the appropriate type of review being done. Example: Check "Routine Review" if reading cases for final decision prior to data entry of case decision. Check "Other" and enter "Random Sample" if reading cases as part of a random sample of case decisions as required by regulations.

Third Section

Indicate type of error found by completing this section. The column on the left lists all the grant categories. The headings indicate the type of error.


Doc = Documentation error. Example: Worker did not sign case decision record form.

Cal = Calculation error. Example: Bills in case file add up to $650 but worker allowed $750.

Pol = Policy error. Example: Worker allowed replacement of furniture in two bedrooms for a single person household.

Dmg Asses = Damage assessment error. Example: Inspector recorded need to remove 400 sq. ft. of sheetrock but did not include amount for replacing the sheetrock.

Mail Q = Letter never sent.

Letter Choice = Wrong letter sent.

Result = Overpayment or Underpayment.

$ Amt = Dollar amount of error.

Explanation of error = See examples above for typical explanations of errors.

Case Disposition




Fourth Section

To be completed by Person Making Correction — Worker completes section and describes how error was corrected.