Appeals Clerical Rotation 1 Responsibilities

The following chart identifies the tasks assigned to Rotation 1:

CLERICAL ROTATION 1
Process State and ACA Hearing Requests Request Presiding ALJ Listing
Create State Hearing Numbers Upload SOPs
Create Hearing Folders Requesting SCOPE SOPs
Assign Cases Upload Withdrawals
AO Requests for State State and ACA Hearings Tallies
Changes to Calendar App Reg Requests for CalHEERS ACA Cases
Calendar (SFT) - State and ACA Hearing Requests Received without IHSS Case numbers
Interpreter List Rehearing/Reopening Requests
ALJ State Hearing Data Folders and Labels

State and ACA Hearing Requests

State and ACA Hearing requests are processed by clerical Rotation Group 1. 

When a Hearing Request is received from the State it is recorded in the SHS and sent to the County. SHS performs all the scheduling and tracking, but it does not interface with CalWIN. 

This process is called variously, “State Hearing,” “Appeal,” or “Fair Hearing.” The terms are used interchangeably.

Note: All requests must be date-stamped: It is critical to determine Aid Paid Pending (APP) and to establish the filing date. 

Hearing Requests Received From the State

All forwarded hearing requests (received by Rotation 2) via SFT from the State will be date-stamped and placed in the State Basket for processing by Rotation 1: 

Clerical Staff - Rotation 1

  1. Retrieves hearing request from the designated State Basket.
  2. Makes one copy of the hearing request.
  3. Prints the CalWIN Case Details (Portrait mode) on a Yellow State CalWIN sheet SCD 2376.
  4. Prints the Programs and Case Members pages (Landscape mode) on regular copy paper.
  5. In RED ink, verify printed Case Details information on the CalWIN sheet:
    1. Status: Place a check mark if status is Open; circle if status is Pending or Closed.
    2. Language: Place a check mark if English; circle if non-English and write language next to it in CAPITAL letters.
    3. Address: Place a check mark if the address is the same on the Hearing Request; if different, write address next to it.
    4. Phone number: Place a check mark if the phone number is the same on the Hearing Request; if different, write phone number next to it. 
    5. Case Load: Write Case Load unit above Programs. 
  6. In RED ink, complete the empty fields:
    1. Filing Date: Provided on Hearing Request or found in SHS; or provided on ACA Hearing Request. 
    2. Received Date: Date-stamped by Appeals.
    3. Claimant: Found on Hearing Request.
    4. SSN: Can be found in CalWIN if not provided on Hearing Request or in SHS.
    5. A/R (Authorized Representative): Found on Hearing Request or in SHS, if applicable.
    6. Program(s): Circle the corresponding programs provided on Hearing Request or in SHS; MC for ACA.
    7. State Hearing No. or ACA #: Provided on all Hearing Requests received from the State and ACA.
  7. Enter case information into the State Hearing Log under the Clerical section.

Hearing Requests Received From Clients

Hearings requests from clients are received (by Rotation 3) via mail, fax, in-person or SFT (by Rotation 2) and will be date-stamped and placed in the State Basket for processing. 

When making copies of the hearing request,

  • make 2 copies of the original envelope it came in and then “burn bag” the original. 

When a Hearing Request from another office is received containing an IDM bar code,

  • “Burn bag” the bar code immediately instead of making copies and including them in the file. (When the file is IDM’ed after closing, that bar code is read, therefore the file is separated during uploading.)
  • Verbal requests for State Hearings can only be submitted directly to the SHD by calling 1-800-952-5253. 
  • Verbal requests for Affordable Care Act (ACA) Hearings can only be submitted directly to the ACA by calling 1-855-795-0634. 

When a State Hearing request is received from a client, the Clerical staff processes the request as follows:

Clerical Staff - Rotation 1

  1. Make a copy of the Hearing Request. 
  2. Make two copies of the included envelope the request came in and “burn bag” the original envelope. 
  3. Print the CalWIN Case Details (in Portrait mode) on a Yellow State CalWIN sheet SCD 2376.
  4. Print the Programs and Case Members pages (in Landscape mode) on regular white copy paper.
  5. In RED ink, verify printed Case Details information on the CalWIN sheet:
    1. Status: Place a check mark if status is Open; circle the status if Pending or Closed.
    2. Language: Place a check mark if English; circle if non-English and write language next to it in capital letters.
    3. Address: Place a check mark if same as on Hearing Request; if different, write address next to it.
    4. Phone number: Place a check mark if same on Hearing Request; if different, write phone number next to it.
    5. Case Load: Write the Caseload # above Programs. 
  6. In RED ink, complete the empty fields: 
    1. Filing Date: Envelope postage date, fax date, or Filing Date provided by SHD or ACA Hearing Request.
    2. Received Date: Date-stamped by Appeals Unit.
    3. Claimant: found on Hearing Request or name of the person whose benefits are affected
    4. SSN: can be found in CalWIN if not provided on the Hearing Request or in CIBP SHS
    5. A/R (Authorized Representative): found on Hearing Request or in SHS, if applicable
    6. Program(s): circle the appropriate corresponding program
    7. State Hearing No.: create SH# in SHS for new case
  7. Enter case information into the State Hearing Log under Clerical section.

Creating State Hearing Numbers

Before creating a new State Hearing Number: 

  1. Check the State Hearing Log and SHS for any existing cases; if there is already an existing case, check with the assigned Appeals Officer to see if the request is regarding a new issue and if a new State Hearing Number is required. 
  2. Access CIBP SHS by entering RACF User ID and PW.
  3. Enter Appeals Clerical Login:
    1. ID: 4302
    2. PW: STC
  4. From Master Menu, select INTAKE MENU (option 2) then PREHEARING (option 1).
  5. Select Desired Action Code 01 to DIRECT CASE ADD.
  6. Enter 43 for Resident County (43 00).

    1. Note: If it is a CAPI case, enter 43 for Resident County followed by 79 for Region code (43 79).

  7. Enter the Last and First Name of the CalWIN Case.
  8. The case number (SH#) in the top left corner of the screen will be automatically generated.
  9. Priority Codes
    1. For CF Only: enter 90
    2. For everything else: enter 60
  10. Processor Code is always: 02.
  11. Aid Codes
    1. 01 = CW, FC, CAPI, AAP, WTW, KINGAP
    2. 05 = MC
    3. 06 = CF
    4. 10 = IHSS
  12. Enter the verified Street, City and Zip Code from the Hearing Request.
    1. If the address is non-CA, take a screen shot and email it to CSU requesting an address correction.
  13. Authorized Rep: Enter A to add Authorized Rep info in the next screen.
  14. Claimant (if different from Case Name) is the individual requesting the appeal.
  15. Enter Language if listed on the hearing request.
  16. Enter Phone Number provided on the hearing request
    1. If there is an Authorized Rep, enter the phone number of the AR instead of the Claimant’s.
  17. Enter Social Security Number of the Claimant.
  18. Hit enter to proceed to the AR info screen (if applicable) or to successfully create the new State Hearing Number.

Creating Hearing Folders

  1. Create a Hearing Folder for each case: hole punch a 2-tab manila folder and prong fasteners.
  2. Create a State Hearing or ACA Hearing label.
  3. Write your Initials in the fields under “Clerical use only” for:
    1. Rqst: once request has been received by Rotation 1
    2. HR: write “SH” if forwarded by State or ACA with hearing number already created
    3. LOG: once case information is entered into the State Hearing Log
    4. CPY: once copies have been made of the Hearing Request
    5. FLDR: once folder has been completed.
  4. Forward completed Hearing Folder to Appeals Supervisor and complete “Date to Sup” in the State Hearing Log.
  5. Create a State Hearing or ACA Hearing label.
  6. Prepare Hearing Folder.
  7. Write your Initials in the fields under “Clerical use only” for:
    1. Rqst: once request has been received by Rotation 1
    2. HR: once new SH# has been created
    3. LOG: once case information is entered into the State Hearing Log
    4. CPY: once copies have been made of the Hearing Request
    5. FLDER: once folder has been completed.
  8. Forward completed Hearing Folder to Appeals Supervisor and complete “Date to Sup” in the State Hearing Log.

Assigning Cases

When a case folder is returned from the Appeals Supervisor and has been assigned to an AO: 

  1. Update the worker number in the CIBP State Hearing System (SHS) only. (The Appeals Supervisor will enter assigned AOs into the State Hearing Log before returning folders.)
  2. Click the Passport 2010 icon to sign into CIBP SHS with your DSS RACF User ID provided by the State.
  3. Sign into the SHS window with Clerical ID Number: 4302 and Password: STC.
  4. Select Option 2 for INTAKE MENU.
  5. Select Option 1 for PREHEARING.
  6. Tab over to the Desired Action Code and enter 07 for DIRECT ADD, CHANGE, DELETE.
  7. Tab over to enter the State Hearing Number as the Case Number: 16 ### #### and hit Enter.
  8. Tab until the Processor Code field is reached and enter: 02.
  9. Tab until the Cnty Worker Number field is reached and enter the worker number (from PG##) as: ##0.
  10. Print the SHS page and place in the folder. The case folder is now ready to be forwarded to the clerk responsible for internal TMT’s.

Appeals Officer’s Requests for State

Direct emails to the State Customer ServiceState Customer Service email <SHDCSU@DSS.ca.gov> for any request that an AO makes for follow up (decisions etc.), uploading/ downloading to SFT. Request for missing hearing info, delete duplicated case, wrong county assigned, add/remove county involved, phone hearing request, etc.

To Re-code cases to DDSD for the Disability Hearings Calendar or for DDSD Withdrawals, email the State Disability Hearings BureauState Disability Hearings Bureau <SHDDHB@DSS.ca.gov>

To Re-code Cases to the SCOPE Unit, send email request to <ScopeOfBenefits@DSS.ca.gov>, and Cc: <SalvadorGarcia@DSS.ca.gov>

Medi-Cal (MC) cases may belong to the Scope UnitScope Unit if the issue is regarding managed care, grievances against a doctor or health plan, medical devices or providers, or any other matters that may be beyond the County’s “scope”.

For any RFA/HarrisRFA/Harris unit questions regarding cases, dismissals, postponement requests, bifurcations, decisions, etc., direct e-mails to the RFA/Harris central inbox <SHDRFA@dss.ca.gov>

Calendars

During the entire month of Rotation 1 Duties, the clerical assigned is responsible for all updated calendars and distribution; this includes the following months’ Hearings Calendar. (Ex. Current month is January. After January Hearings, February’s Calendars are uploaded. Print and distribute any updated Calendars up until the end of January). Delete all Calendars for the current month after Hearings are held, do not delete the following months’ Calendars.

Changes to Calendar

  1. For any change requests made by the assigned AO or Appeals Sup, send to SHDCSU or the SHDACA Bureau.
  2. Un-calendared Case listings will be uploaded to SFT by the State and/or forwarded by the Appeals Supervisor.
  3. Email Melissa Tostado <Melissa.Tostado@DSS.ca.gov> for questions regarding scheduling, the Un-calendared Case listing for duplicates, withdrawals, companion cases, incorrect cases, in person requests, or any cases that have special scheduling requests or accommodations.

Calendar (SFT) - State

  1. Print out and sort Calendars by Date and then Regions (Tues 09, 50, 83... Wed 09, 50, 83 etc.)
    1. 09 (SCOPE cases) We need to contact State for everything (SOP)
    2. 50 (Phone)
    3. 83 (IHSS), 79 (CAPI), 93
    4. 00
    5. 46
  2. Number all the pages at the top of the sorted and ordered Calendar. The final version of the calendar will have circled page numbers.
  3. Check if all cases have been assigned to an AO „Y 000 = Not assigned, highlight and figure out if the request has been received and if there is an existing file or not. If there is no request or file, request the missing docs from SHD and create a file to be assigned. If the request has been assigned, write the PG # next to it (ex. ##0)
  4. E-mail a copy to AO Supervisor & Lead right away; Cc: AOs
  5. Check SFT every day for any updated calendars, print them and do the same steps as 1-3
  6. One week before the Hearings, make copies for the Receptionist, Clerical & AOs (# the Pages)
  7. On the days of the Hearings, the Receptionist will call upstairs with the page number of the Calendar
    1. Write the check-in time on the left hand side in front of the scheduled time.
    2. Write the check-in info for Time, Claimant Name, and PG# on the white board outside of AO Supervisor’s office (AM Hearings on left side of the board and PM Hearings on the right)
    3. Notify the AO that the client is here.

Additional Regions that have a separate calendar from the monthly State Hearings Calendar are:

  • Region 20 (Harris)
  • Region 95 (DDSD/DED/Disability/Z-Cases)

Calendar (SFT) - Affordable Care Act (ACA)

  1. Print out Calendar and highlight Santa Clara County Cases:
    1. DUAL or MAGI (Modified Adjusted Gross Income) are both our cases
    2. Involves County, our case
    3. If CC (Covered California), no action needed (State will take care of it).
  2. Write the PG# on each of our cases and then make a copy for all AOs, and AO Lead.
  3. Check every day for updated calendars in SFT.
  4. Compare State-uploaded Case Listings on SFT to hearing report.
  5. Check for In-Person APTC (Advanced Premium Tax Credit Medi-Cal program) hearings.
  6. The week of ACA Hearings, make the receptionist and the clerical a copy of the most current Calendar (should have already been distributed to the AOs, and AO Lead).

Interpreter List

  1. When Calendar is printed, 
    1. Attach a Routing Slip,
    2. Place is Inbox (he will route it to the AOs and return it when completed).
  2. Scan and email the finalized State Hearing Interpreter List 2 weeks before scheduled hearings to; Rocio Olguin <Rocio.Olguin@DSS.ca.gov>, Cc: Back Up Keli Rutherdale <Keli.Rutherdale@dss.ca.gov>.
  3. Any changes to the interpreter list up until the hearing should be emailed to Rocio and Keli (specify the changes).
  4. For any required ACA Hearing Interpreters, e-mail requests to Melissa Fernandez <Melissa.Fernandez@dss.ca.gov>, Cc: Christina Fong <Christina.Fong@dss.ca.gov> and Leslie Redfearn <Leslie.Redfearn@dss.ca.gov>.

ALJ State Hearing Data Folders and Labels 

  • For refills of the manila top tab single-ply letter 2B fastener State Hearing Data folders, email request to SHD Central Support ATTN: Ronda at <SHDCentralSupport@DSS.ca.gov>
  • For matters relating to State Hearing labels sent out by CDSS (CA Dept. of Social Services) SHD, contact Joshua Johnson by email <Joshua.Johnson@dss.ca.gov> or direct phone number: (916) 654-0866.
  • Hole-punch and assemble folders with the “State Hearing Data” form on the same side as the tab.
  • State Hearing Data folders are to be filed in the second divider of the document organizer located by the Appeals Officers. They’re used by AOs for cases heard by in-person ALJs.

Request Presiding ALJ Listing

The week before State hearings, email Perla <Perla.DelRosario@DSS.ca.gov>, Cc: Jenny <Jenny.Zhang@DSS.ca.gov> to request the names of presiding judges (In-Person and Back-Up Phone or Video) for hearings. Copy and on the request e-mail and forward the response to them after it is received.

Statement of Position (SOP) - General Jurisdiction SFT

  1. Scan SOP
  2. Save As: SOP - LAST NAME, FIRST SH#
  3. Upload into SFT
    1. CouSantaClara > SOP > Browse > Select File > Open > Upload File
  4. For SH SOP uploads, send an email to SHD <SHDCentralSupport@DSS.ca.gov> including the screen shot to notify them of the upload, Cc: Appeals Officer.

ACA SFT

  1. Scan SOP
  2. Save as: SOP - LAST NAME, FIRST SH#
  3. Upload into SFT
    1. CouSantaClara > SOP to CC > Browse > Select File > Open > Upload File
  4. For ACA SOP uploads, send an e-mail to <SHDACAOperations@DSS.ca.gov>, including the screen-shot to notify them of the upload and its location, Cc: Appeals Officers.

Requesting SCOPE Statement of Positions (SOPs)

SOPs for SCOPE cases will be uploaded by close of business the day before the scheduled hearing date. Email Scope Unit at least two days in advance for a reminder to upload documents to SFT. 

Send to <ScopeOfBenefits@DSS.ca.gov>, Cc: <SalvadorGarcia@DSS.ca.gov>, and.

Withdrawals - General Jurisdiction SFT

  1. Scan Withdrawal
  2. Save as: WITHDRAWAL - LAST NAME, FIRST SH#
  3. Upload into SFT
    1. CouSantaClara > Withdrawal > Browse > Select File > Open > Upload File
  4. For SH Withdrawal uploads, send an email to SHD <SHDCSU@DSS.ca.gov> including the screen-shot to notify them of the upload, Cc: Appeals Officers.

Note: SH Withdrawals uploads to SFT are not common, as WD/CWD/VWD are usually noted later on the hearing tally. An example of why a SH withdrawal might be uploaded is to prevent future scheduling and notification of hearing mailed to the claimants.

Affordable Care Act (ACA) SFT

  1. Scan Withdrawal
  2. Save as: WITHDRAWAL - LAST NAME, FIRST SH#
  3. Upload into SFT
    1. CouSantaClara > Withdrawals > Browse > Select File > Open > Upload File
  4. For ACA Withdrawal uploads, send an e-mail to <SHDACABureau@DSS.ca.gov> including a screen shot to notify them of the upload and its location, Cc: Gayle Walker <Gayle.Walker@DSS.ca.gov>, Robyn Valencia <Robyn.Valencia@DSS.ca.gov>, and Appeals Officers.

Hearings Tallies

State Hearings Tally

The State Hearings Tally Excel worksheet is located in the S Drive under ASB Clerical > Appeals Clerical.
During Hearing Week, AO Lead will provide a calendar at the end of the day. For each hearing, one of the following should be circled:

  • Hearings Heard
  • Postponement (PP)
  • Conditional Withdrawal (CWD)
  • Withdrawals (WD)
  • Nonappearance (NA)
  • Verbal Withdrawal (VWD)
  • Verbal Conditional Withdrawal (VCWD)
  1. Write the Hearing Date and Tally numbers on the State Tally Form then scan it and email to Perla DelRosario & Jenny Zhang, Cc: AO Supervisor and Lead.
  2. Enter State Hearings Tally information into Appeal Tally spreadsheet found in S Drive under Appeals > Appeal Tally Excel Worksheet.

ACA Hearings Tally

ACA Hearings Tally Excel worksheet is located in the S Drive under ASB Clerical > Appeals Clerical. 

On ACA Hearing Day, or will provide a calendar at the end of the day with case status completed.

  1. Write the Hearing Date and Tally numbers on the ACA Tally FormACA Tally Form. 

  2. Scan and email to AO Lead and AO Supervisor.
  3. Enter ACA Hearings Tally information into Appeal TallyAppeal Tally spreadsheet found in S Drive under Appeals > Appeal Tally Excel Worksheet.


Application Registration Request for CalHEERS Affordable Care Act (ACA) Cases

If case info for an ACA Hearing Request cannot be found in CalWIN, it has not yet been App Reg’d. 

  • Send an e-mail requesting assistance with App Registering the case to: Linda Zuniga and Esmeralda Martinez, Cc: Ezequiel Contreras-Murillo and.
  • Provide: Case Name, Date of Birth, Last four of SSN, and CalHEERS#CalHEERS# (California Healthcare Eligibility, Enrollment, and Retention System)


Hearing Requests Received without IHSS Case Numbers

For IHSS hearing requests forwarded by the SHD without an IHSS case number:

  1. Identify the individual in CalWIN and MEDS with any information provided on the hearing request
  2. EmailEmail request of the IHSS# for the individual to the IHSS Liaison: Renae Bhader <Renae.Bhader@ssa.sccgov.org>


Rehearing/Reopening Requests

Rehearings can be requested by a claimant who was present for their scheduled hearing and disagrees with the presiding ALJ’s decision.

  • A rehearing of the decision may be requested by mailing a written request to the Rehearing Unit, 744 P Street, MS 9-17-37, Sacramento, CA 95814 within 30 days of receiving the decision.
  • The time limit may be extended up to 180 days only upon a showing of good cause.
  • In the rehearing request, the claimant should state the date they received the decision and why a rehearing should be granted.
  • If additional evidence is presented, the claimant should provide descriptions and explanation of why it was not introduced before and how it would change the decision.

Reopening may be requested by a claimant who failed to appear for their scheduled hearing.

  • The SHD will notify the county of reopening requests and any approved reopening requests will be forwarded to the county via SFT.
  • A new SH#, State Hearing Log entry, and internal TMT assignment are not created for reopened hearings.

Related Topics

Specialized Bureaus

Appeals Unit

Appeals Clerical Rotation 1 Responsibilities

Appeals Clerical Rotation 2

Appeals Clerical Rotation 3

Closing and Filing Cases

Imaged Document Management (IDM)

Appeals Clerical Rotation 4

County Hearing Requests

Foster Care Eligibility Bureau

Collect Applications

Register Applicants

Case Transfers

Updating Provider Table

Providing CalWIN Case Information to Social Workers