139 NOTICES OF DECISION (NOD) SR 99-03, 02/99 (FAM-A)

Notify individuals of case decisions on Form 805, Notice of Decision (NOD). Each Notice of Decision must include all of the following:

• the name, address, and telephone number of the District Office,

• the individual’s name and address,

• the case number and current date,

• the name of the worker to contact for more information, when possible,

• the effective date of the action,

• an action message which describes the effect of the decision, the positive or negative change, or other action which requires notification to the individual, and

• the calculation which determined the benefit level and amount, when the action being taken is the result of a financial eligibility determination.

A Notice of Decision will also include:

• a reason message which describes why a negative action is occurring, and the policy manual reference(s) on which the action is based or

• the names of eligible individuals in the household when a case is determined to be eligible. A reason message may also be included when more information is needed to explain a positive action.

The action and reason messages are derived from a financial eligibility calculation performed by New HEIGHTS, a worker-selected entry in New HEIGHTS, or a decision by the worker for which New HEIGHTS may not be able to provide either a timely or a detailed message.

Include Form 810, Notice of Rights and Responsibilities, with every NOD.

Exceptions:

• Notification of eligibility for Healthy Kids-Silver medical insurance is provided by New Hampshire Healthy Kids Corporation.

• Notify individuals of approval or denial of a claim of good cause for refusing to cooperate in establishing paternity or securing support payments on Form 781, Good Cause Claim Decision.

• Notify individuals of recoupment or corrective payments on Form 205, Notice of Underpayment or Overpayment