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Get OR MSC 0443 2018-2024

T this form. You can also use this form to ask for a medical program or food benefit hearing, or you can make an oral request. A DHS or OHA employee can help you complete this form. Claimant or claimant s representative completes this part Is claimant English speaking? Yes No If no, claimant s preferred language: Do you want your hearing documents in an alternate format? Yes No If yes, please specify type of alternate format: The administrative law judge may conduct the hear.

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