Request for Hearing 401-01-35-15

(Revised 4/1/12 ML #3322)

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SFN 162, Request for Hearing form is used when a Crossroads Applicant or Recipient chooses to request a fair hearing due to action taken regarding Crossroads benefits.

 

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms. (54kb pdf)

 

E-Forms are presented in Adobe Acrobat and require the Adobe Acrobat reader. If you do not currently have Adobe Acrobat reader installed, you may download a free copy by clicking the Get Adobe Reader icon below.