Appeals Business Process

• Initiates the hearing request

• Receives and date stamps the state hearing request.

  • Note: Questionable state hearing requests are forwarded to the Appeals Supervisor/Lead for assessment.

• Initiates appeals case review forms and folder.
• Reviews and prints screens from CalSAWS/MEDS such as Case Summary and All People Associated with the case (if applicable).

  • Note: For conflicts between systems and hearing request, inform the Appeals AO Lead to clarify.

• If hearing requests is:
  • Received by the State:
    • IDs the case name in the SHS and obtains the 9 digit state hearing number.
    • Documents the state hearing number on the Appeals Case Review form.
  • Received by the County Appeals Unit:
    • Date stamps the request to establish the filing date and APP determination.
    • IDs client in SHS and ASB Clerical Log
    • Adds additional filing date to record in SHS if request is a duplicate.

    • Note: For clients not known to the SHS and/or when request is not a duplicate, create a new SHS record.

• Creates a Hearing Request folder.
• Updates ASB Appeals Clerical Log.
• Completes clerical portion of the Appeals Case review form.
• Submits hearing request folder to Appeals Supervisor for assignment.

• Receives Hearing Request folder from clerk.
• Identifies the hearing issue and program through case information, correspondence and case comments in CalSAWS.
• IDs case in CalSAWS and Assignment log to identified if previously assigned AO.
• Assigns case to next available or previous AO as appropriate.
• Updates Assignment log (AO number and assignment date).
• Forwards State Hearing folder to the Appeals Clerical to update in SHS.

• Receives folder from Appeals Supervisor.
• Updates SHS with the assigned AO worker number for changes or corrections.
• Prints out SHS Case Change Screen.
• Copies Hearing request State Hearing Cover Sheet
• Sends Hearing Request folder to assigned AO.
• Requests case folder though CDS as needed by AO using a “Case Tacking Request Form:” (SCD 2292).

• Receives Hearing Request folder from Appeals Clerk.
• Reviews Hearing Request issue.
• Preforms preliminary case review and determines Aid Paid Pending (APP)
• Submits Fair Hearing Communication, SCD 2597 and copy of Hearing request to clerical as follows:
  • Snap scans and emails to BSC, IHSS, FC, R&L.
  • For all other offices follows TMT procedures

  • Note: For closed cases, sends documents to Appeals liaison for EW assignment.

• Completes and submits State Hearing Cover Sheet to the appeals clerk's basket.

• Receives documents from Appeals AO for processing 
• Records request in Maintain Filing Information for State Hearings in CalSAWS as needed.
• Completes the following tabs [Issues][Claimant][Auth Rep][Scheduling] in CalSAWS Maintain Hearing Details window.
• Returns packet to Appeals AO.

• Receives assigned hearing case file.
• Reviews APP determination
• Determines claimant’s: issue, time period, evidence required.
• Reviews information in VACS for OP/OI related cases.
• Reviews case in CalSAWS and IDM

  • Note: For IHSS cases which are not in IDM and CalSAWS, refer to IHSS process.

• Determines responsible District Office for Action.
• Sends the form “Authorized Representative” (DPA 19) to client as required. Reviews county action as follows:
  • Is Withdrawal or Conditional Withdrawal requested/granted?
    • Yes:    
      • Follows Withdrawal and Conditional Withdrawal process
    • No:   
      • Prepares a Position Statement.
      • Requests and notifies witnesses for Hearing.
      • Follows State Appeals Hearing Day Process

• Determines that a TOA review is required.
• Completes the "TOA Review for State Hearings" (SCD 2605) form and sends it along with the SCD 2597 and supporting documents to: SCC_TOA_Requests@ssa.sccgov.org and copies the Appeals Supervisor. 

• Receives TOA Review request from Appeals AO for processing. 
• Processes TOA review.
• Completes SCD 2605 form and returns along with required supporting MEDS screens and CalSAWS pages by the designated due date to the Appeals AO and Appeals Supervisor.

• Downloads the Hearing Schedule from the State Secure File Transfer (SFT) System.

  • Note: For cases that have no assigned Worker number, follow Step 3 of the Initial Process for hearing request chart.

• Provides AOs with copies of the Hearing Schedule.
• Retains hearing requests tables for the Administrative Law Judge (ALJ) folders upon hearing.
• Prepares Hearing Room.

• Conducts daily tracking during Hearing Week.

• Coordinates the appearance of witnesses and interpreters, prior to the Hearing Date as specified in section
• Appears at the Hearing
• Updates Hearing Schedule (for each Hearing Day)
• Updates CalSAWS as appropriate.

• Forwards completed Hearing Schedules to Appeals Clerk at the end of each Hearing Day.

• Receives completed Hearing Schedules from the Appeals lead.
• Sends the completed Hearing Schedules to the State and to the Administrative Support Bureau (ASB) Management Analyst (MA) via email and cc's the Appeals Supervisor and AO Lead.

• Receives completed Hearing Schedule form.
• Creates a report for submission to DSR and Management.

• Receives Hearing Disposition from SFT.
• Sends soft copies to the assigned AO and Appeals Supervisor.

• Receives Hearing Disposition from the Appeals Clerk.
• Reviews Hearing Disposition and required action.
• Forwards documentation (SCD 2294, SCD 1562 and copy of the Hearing Disposition) to the appropriate District Office for processing for any required action.
• Updates the [Issues] [Tracking] [Decision] and [Comments] tabs in CalSAWS Maintain Hearing Details window.
• Prepares case for Imaging and submits to the Appeals Clerk.

  • Note: If not completed within time frame, follows Compliance Request and Escalation process as required.

• Receives case from Appeal AO and initiates IDM process.

• Receives the soft copy of the Hearing Disposition from the Appeals Clerk.
• Reviews information in CalSAWS Caseload listing.
• Emails copy of Hearing Disposition to the specific Program Coordinator (if granted).

• Reviews case to determine county’s action.
• Contacts the claimant or AR to discuss and/or resolve the issues when the county’s action is NOT correct or when it is correct and a hearing is not warranted.
• If withdrawal is:    
  • Requested:   
    • Sends the Compliance Response to Withdrawal or Conditional Withdraw (DPA 315) to the client for approval and signature.
    • Requests Appeals Clerk to create a request for District Offices as follows:
      • Snap scans and emails documents to BSC, IHSS, FC, R&L.
      • For all other offices follows TMT procedures.
    • Signs DPA 315 when it is returned by the client.
    • Sends a copy of the DPA 315 to the client/AR and to District Office as available.
    • Updates CalSAWS.
    • Closes and forwards the case file to the Appeals Clerk.

    • Note: Follows up with District Office Compliance.

  • Is NOT requested or Hearing is warranted:    
    • Prepares a Statement of Position.
    • Requests and notifies witnesses for hearing
    • Follows State Appeals Hearing Day procedures.

• Creates compliance request according to District Office Notification as requested by the Appeals AO.
• Receives case files from AO and prepares/initiates for IDM process.

• Receives Hearing Request folder already prepared by the Appeals Clerk
• Reviews documents and program(s) issue(s).
• Performs preliminary case review and determines APP eligibility as follows.

• Completes AO portion of the State Hearing Cover Sheet (yellow form).
• Submits State hearing Cover sheet, SCD 2597 and copy of Hearing request to Appeals clerk’s basket.

Note: Client has the option to waive APP to avoid potential O/P and O/Is.

• Receives documents from Appeals AO for processing
• Snap scans and emails documents to BSC, IHSS, FC, R&L and follows TMT procedures for all other offices.
• Records request in Maintain Filing Information for State Hearings in CalWIN as needed.
• Completes the following tabs [Issues] [Claimant] [Auth Rep] [Scheduling] in CalSAWS Maintain Hearing Details window.
• Returns packet to Appeals AO.

Note: For SCD 555, follows the Compliance Request and Escalation Process for District Office, as appropriate.

• Receives instructions to create Compliance Request for District Office.
• Creates compliance request according to District Office (DO) as follows:
  • For District Offices that use CCS Management Tool (TMT), if the case is: 
    • Active and assigned to an EW:   
      • Creates a TMT for subsequent assignment.
    • Active and unassigned to an EW or Closed:  
      • Creates a TMT
      • Emails the designated district office control clerk and requests assignment.

      • Exception: Case assignment requests for the Benefits Assistance Center (BAC) will be sent to the Social Services Program Manager (SSPM) who oversees Clerical staff.

    • Returns folder to Appeals Officer (AO)
    • Monitors TMT for assignment and completion as follows:
      • TMT assigned within 24 hours?
        • YES:    
          • No action needed
        • NO:
          • Emails Appeals Liaison and cc’s Appeals Supervisor
      • TMT assigned within 24 hours?  
        • YES:    
          • No action needed
        • NO:    
          • Informs Appeals Supervisor
  • For District Offices that DO NOT Use CCS -TMT, if the case is:   
    • Active and assigned to an EW: 
      • Scans documents
      • Emails materials to the Unit Supervisor and cc’s Rotating Appeals Liaison.
    • Active and unassigned to an EW or Closed:  
      • Scans documents
      • Emails materials to designated control clerk.
    • Documents request in Compliance Request Log

• Emails supervisor and appeals liaison for TMT case assignment, after being informed by the Appeals clerk.

• Monitors assigned TMT for completion as follows:
  • If assignment not completed within:    
    • 10 days:   
      • Emails Unit Supervisor for assignment completion
    • 14 days:   
      • Escalates delinquent assignment completion to the appeals supervisor and liaison.

• Emails Unit Supervisor requesting assignment completion
• Escalates delinquent assignment completion to Appeals SSPM, if not completed within 17 business days.

• Emails District Office SSPM requesting assignment completion.