Get Request For Fair Hearing - Doa.wi.gov

Filling out the REQUEST FOR FAIR HEARING form is an essential step for individuals seeking a review of decisions related to benefits. This guide provides clear and supportive instructions to help users complete the form accurately and effectively.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the document and open it in your browser.
2. Begin by entering your full name in the designated field. This information is crucial for identifying your case.
3. Next, provide your phone number. Ensure it is accurate so that the agency can contact you if needed.
4. Fill in your social security number as required. This information helps verify your identity.
5. Complete your mailing address, including street, apartment number, city, zip code, and county or agency.
6. Include your CARES number in the corresponding field to link your request to the appropriate system.
7. Indicate the effective date of the adverse action that prompted your request by specifying the date your benefits will change.
8. If applicable, indicate whether you want your benefits to continue during the appeal process by selecting 'yes' or 'no.'
9. Check the type of benefit and action taken that you are appealing from the provided options, such as medical assistance and food share details.
10. State the reason for your hearing request in the designated section. If more space is needed, continue on an additional page.
11. Sign the form, ensuring to specify your relationship to the applicant if necessary, such as guardian or power of attorney.
12. Finally, review your form for accuracy. Make any necessary corrections, then proceed to save the changes, download, print, or share the completed form as required.

Complete your REQUEST FOR FAIR HEARING form online today to ensure your voice is heard.