Form Dpa 284 Aid Pending Decision

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
AID PENDING DECISION
Claimant _____________________________________________________________________________________________
County ______________________________________________________________________________________________
State Hearing held on______________________________________ 20________
State Hearing No. ______________
After considering the evidence presented at this hearing and based upon the record, it is my determination that the issue(s)
presented is:
Fact - Judgment
1.
____________________________________________________________
Which is
Law - Policy
Fact - Judgment
2.
____________________________________________________________
Which is
Law - Policy
Fact - Judgment
Which is
3.
____________________________________________________________
Law - Policy
Other: ___________________________________________________________________________________________
_____________________________________________________________________________________________________
Pursuant to Manual of Policies and Procedures (MPP) Section 22-072.5 and (MPP) Section 22-072.7:
The county is required to pay aid pending the final decision in this matter only as to issue(s)
Number:
________________________________________________________________________________________________
The county is not required to pay aid pending the final decision because:
The claimant's state hearing request was not filed in a timely manner.
The issue is one of Law - Policy.
The claimant has withdrawn or abandoned his/her request for a state hearing.
The claimant has voluntarily and knowingly waived aid paid pending.
The county action is suspended pending receipt of the state hearing decision.
Overpayment Adjustment
Sanction
The county shall retroactively reinstate claimant's aid and shall pay aid pending because adequate notice was not
provided and the county's action involved termination or reduction of aid. MPP Section 22-073.254 and MPP Section
22-049.523.
Other
___________________________________________________________________________________________________
`
____________________________________________________________________________________________________
____________________________________________________________
_____________________________________
ADMINISTRATIVE LAW JUDGE FOR THE DEPARTMENT OF SOCIAL SERVICES
DATE
cc: Claimant
Case Record
After this hearing, and within 10 calendar days from receipt of this aid pending decision, the claimant or the county may submit,
in writing, a request to the State Hearings Division, 744 P Street, M.S. 17-50, Sacramento, CA 95814 for reconsideration of
this aid paid pending decision. Each party shall be notified of the request and the result of the reconsideration.
Nothing shall prohibit the county from instituting any appropriate changes in the recipients grant while a state hearing is
pending, provided that the basis of the proposed action is different from the action upon which the recipient is receiving aid
pending. Claimant should be aware that Food Stamp benefits will terminate when the household's certification period ends.
DPA 284 (2/05 )

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