Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Fill in your personal information at the top of the form, including your name, case name, case number, and other identifying details as requested.
3. Provide the date and your contact information, ensuring to include the days you are available in the office and your telephone number.
4. In the section for the required actions, select any applicable options such as whether you need an interview in-person or via telephone.
5. Review the section requesting proof of items that need verification and check off the appropriate boxes indicating what you will provide. Make sure to gather the necessary documentation as outlined.
6. If you disagree with any action taken regarding your case, include a statement about your request for a fair hearing within the specified time frame.
7. If you wish to withdraw your application or discontinue benefits, provide a written reason, sign, and date the section designated for this purpose.
8. For each proof item required (e.g., income, identity, citizenship), prepare the necessary documentation as detailed in the later sections of the form.
9. Once you have filled out all required fields, carefully review your form for accuracy and completeness.
10. Finally, save your changes, and you may choose to download, print, or share your completed form as needed.

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