Get Mi Dhhs Dch-0092-moahr 2019-2025

Filling out the MI DHHS DCH-0092-MOAHR form online can be a straightforward process. This guide will provide step-by-step instructions to assist users in completing the form accurately and effectively.

Follow the steps to complete the MI DHHS DCH-0092-MOAHR online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section 1, provide the name of the client, their telephone number, and social security number. Enter the client's address, including street, apartment number if applicable, city, state, Medicaid ID number, and zip code. Ensure you include the client or legal guardian's signature and the date.
3. Identify the agency responsible for the decision you are appealing. Mention MDHHS and ensure to attach a copy of the letter from the agency that communicated the decision.
4. Clearly state your reasons for requesting a hearing in the provided space. If required, use additional sheets.
5. Indicate whether you have a physical disability or condition requiring special arrangements for the hearing. Provide an explanation if applicable.
6. Specify if you will need an interpreter for the hearing by selecting 'Yes' or 'No'. If yes, indicate the required language.
7. In Section 2, indicate if you have chosen a representative for the hearing. If yes, have them complete and sign Section 3.
8. In Section 3, provide the representative’s information including their name, telephone number, relationship to the enrollee, and address.
9. Complete Section 4 with details about the agency involved in the action being disputed, including their name, contact person, address, and telephone number.
10. After filling out all sections, review the form for accuracy. Finally, save your changes, and choose to download, print, or share the form as needed.

Complete your MI DHHS DCH-0092-MOAHR online today for a smooth hearing request process.