Legal Packet

________________________________________________________________________________

STATE OF TENNESSEE )

) ss.

[COUNTY] COUNTY )

________________________________________________________________________________

[FULL NAME OF APPELLANT],

Appellant,

v.

TENNESSEE DEPARTMENT OF HUMAN SERVICES,

Appellee.

________________________________________________________________________________

REQUEST FOR FAIR HEARING

TENNESSEE DEPARTMENT OF HUMAN SERVICES

ADMINISTRATIVE HEARING SECTION

Case No.: _______________

________________________________________________________________________________

COMES NOW Appellant, [FULL NAME], and requests a Fair Hearing pursuant to

Tennessee Department of Human Services regulations and federal law as follows:

PARTIES AND JURISDICTION

1. Appellant [FULL NAME] is a resident of [COUNTY] County, Tennessee, residing

at [STREET ADDRESS], [CITY], TN [ZIP].

1. Appellee Tennessee Department of Human Services ("TDHS") is the state agency

responsible for administering public assistance programs including SNAP,

Families First (TANF), and TennCare.

1. This Fair Hearing is requested pursuant to the Appellant's right to appeal

adverse agency actions under 7 U.S.C. § 2023 (SNAP), 42 U.S.C. § 601 et seq.

(TANF), and applicable Tennessee Department of Human Services regulations.

1. The Appellant has a protected property interest in public benefits under the

Due Process Clause of the Fourteenth Amendment to the United States

Constitution, which requires notice and an opportunity to be heard before

benefits may be reduced, terminated, or denied.

STATEMENT OF FACTS

1. Appellant applied for [SNAP / Families First / TennCare] benefits on or

about [DATE OF APPLICATION].

1. Appellant's application was assigned case number [CASE NUMBER].

1. On [DATE OF NOTICE], TDHS issued a notice [denying Appellant's application /

reducing Appellant's benefits / terminating Appellant's benefits].

1. The notice stated the reason for the adverse action as: "[QUOTE EXACT

REASON FROM NOTICE]."

1. Appellant disputes this determination for the reasons stated below.

GROUNDS FOR APPEAL

FIRST GROUND: FACTUAL ERROR

1. The notice of [denial / reduction / termination] contains factual errors.

Specifically: "[DESCRIBE THE FACTUAL ERROR - e.g., TDHS incorrectly stated

Appellant's income was $X when actual income was $Y]."

1. Appellant's actual [income / household size / expenses] is as follows:

• Monthly income: $[AMOUNT]
• Household size: [NUMBER] persons
• Monthly rent: $[AMOUNT]
• Monthly utilities: $[AMOUNT]
• Other deductible expenses: $[AMOUNT]

1. Based on the correct facts, Appellant [is eligible / should receive

$[AMOUNT] per month / should not have been terminated].

SECOND GROUND: FAILURE TO CONSIDER ALL INCOME DEDUCTIONS

1. Under federal SNAP regulations at 7 U.S.C. § 2014(e), households are

entitled to deductions for shelter costs, dependent care, and medical

expenses for elderly or disabled members.

1. TDHS failed to properly account for Appellant's:

• [ ] Shelter costs (rent/mortgage and utilities)
• [ ] Dependent care expenses
• [ ] Medical expenses (if elderly or disabled)
• [ ] Child support payments

1. Appellant's shelter costs exceed the standard deduction and should result

in a higher benefit amount.

THIRD GROUND: PROCEDURAL ERROR

1. Under the Due Process Clause of the Fourteenth Amendment, Appellant is

entitled to adequate notice of the reasons for adverse action and an

opportunity to respond.

1. TDHS [failed to provide adequate notice / failed to consider documentation

submitted / failed to conduct required interview / other procedural error:

_____________].

1. As a result, Appellant was denied a meaningful opportunity to respond to

the agency's concerns.

[FOURTH GROUND: CONTINUED BENEFITS DURING APPEAL - IF APPLICABLE]

1. Under 7 U.S.C. § 2023, Appellant is entitled to continued benefits during

the pendency of this appeal if the request is made within the applicable

timeframe.

1. Appellant requests that benefits be continued at the previous level pending

the outcome of this hearing.

RELIEF REQUESTED

WHEREFORE, Appellant respectfully requests that the Hearing Officer:

a) Reverse the decision to [deny / reduce / terminate] Appellant's benefits;

b) Reinstate Appellant's benefits at the correct amount of $[AMOUNT] per month,

retroactive to [DATE OF ORIGINAL DECISION];

c) Continue benefits at the previous level during the pendency of this appeal;

d) Grant such other relief as the Hearing Officer deems just and appropriate.

VERIFICATION

I, [FULL NAME], declare under penalty of perjury under the laws of the State of

Tennessee that the foregoing is true and correct to the best of my knowledge.

See Tenn. Code Ann. § 39-16-702 (perjury is a Class A misdemeanor; false

statements on official documents may result in criminal prosecution).

Executed this ___ day of _____________, 20___.

______________________________

[Appellant's Signature]

[FULL NAME, printed]

[ADDRESS]

[CITY, TN ZIP]

[PHONE NUMBER]

[EMAIL ADDRESS, if available]

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FILING INSTRUCTIONS

Agency: Tennessee Department of Human Services

Administrative Hearing Section

Filing Options:

1. IN PERSON: Submit to your local county TDHS office
2. BY MAIL: Tennessee Department of Human Services

Family Assistance Division

P.O. Box 305200, Nashville, TN 37229

1. BY PHONE: Call 1-866-311-4287 (TDHS Family Assistance)
2. ONLINE: Through the TDHS portal at tdhs.service-now.com

Deadline: Request must be made within 90 days of the date on the notice

(For SNAP: 90 days; For expedited SNAP appeals: 7 days)

Fee: No filing fee required

What to Bring:

• Copy of the denial/reduction/termination notice
• Proof of income (pay stubs, benefit letters)
• Proof of expenses (rent receipt, utility bills)
• Proof of household size (birth certificates, school records)
• Any other documentation supporting your appeal

Hearing Timeline:

• Regular SNAP appeals: Hearing within 60 days of request
• Expedited SNAP appeals: Hearing within 7 days if benefits terminated
• TANF/Families First appeals: Hearing within 90 days

Interpreter: If you need an interpreter, indicate language needed above.

Disability Accommodation: If you need accommodation, describe needs above.

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STATUTES AND AUTHORITIES CITED:

1. 7 U.S.C. § 2023 — SNAP appeal rights: "Any household aggrieved by any

decision of the State agency... shall have a right to a fair hearing."

1. 42 U.S.C. § 601 et seq. — TANF/Families First program requirements and

appeal rights.

1. 42 U.S.C. § 1396 et seq. — Medicaid/TennCare program requirements.

1. Fourteenth Amendment, U.S. Constitution — Due process requires notice

and opportunity to be heard before deprivation of property interests,

including public benefits. See Goldberg v. Kelly, 397 U.S. 254 (1970).

1. Tenn. Code Ann. § 39-16-702 — Perjury statute; false statements under

oath or on official documents subject to penalty.

*This document is for informational purposes only and does not constitute

legal advice. Jurist-Diction is not a law firm. For legal advice specific to

your situation, contact a licensed attorney or your local legal aid office.*

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