Unsigned Waiver 430-05-75-15-35

(Revised 01/01/04 ML2893)

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If an individual chooses not to sign either Part A or B of the waiver OR the individual fails, within two weeks, to respond to a request for a meeting OR fails to attend a scheduled meeting without satisfactory explanation within three days after the scheduled meeting:

1. A hearing will be requested (in person or by telephone).
2. Mail a copy of the SFN 1940 - TANF/Food Stamp Notice of Suspected IPV to the individual.
3. Mail SFN 1087 - Legal Service Organizations to the indiviudal.
4. Mail the following to the Appeals Supervisor at the State Office:

1. SFN 1940
2. A letter detailing the violation.
3. Copies of relevant parts of the Change Report Form, Application, etc.
4. Copies of evidence obtained.
5. A request for legal counsel if necessary.