LIHEAP / ECAP: Fair Hearing Summary Example

The following is an example of a completed hearing summary Form 13MP002E (H-1-A) for a LIHEAP/ECAP hearing.

For Page 1 of the hearing summary the following needs to be completed:

  • Local Office
  • Number
  • Case Name
  • Case Number
  • Hearing Number

Select the Action prompting the hearing request.

Issue: A descriptive paragraph should be written regarding the issue or reason for the hearing request.

  • Enter the date of notice to the client.
  • Enter the effective date of action.
  • Enter any policy sections on which the decision is based.

First Page of Hearing Summary – Sample Issue and Policy

For Page 2, write a narrative on the action taken on the case, the facts supporting the action, and the sources of the facts on which the action

The form must be signed and dated by the person preparing the form and also the supervisor.

Second Page of Hearing Summary – Sample Narrative Text and Signatures.

 

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