Transcription of DIVISION OF HEARINGS AND APPEALS
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DIVISION OF HEARINGS AND APPEALS
DIVISION OF HEARINGS AND APPEALS STATE OF WISCONSIN. DHA-28 (08/09). REQUEST FOR FAIR hearing . NAME PHONE NUMBER *SOCIAL SECURITY NO. MAILING ADDRESS (Street, Apt. #, RFD, etc) *CARES NO. CITY ZIP CODE COUNTY OR AGENCY CASE WORKER OR W-2. WORKER. EFFECTIVE DATE OF ADVERSE ACTION. DATE YOUR BENEFITS WILL CHANGE. If the action affects your MA or FoodShare benefits and your request is received before the effective date, your benefits in most cases, will not stop or be reduced. (Overpayment of benefits may be recovered by the county agency.)
division of hearings and appeals state of wisconsin . dha-28 (08/09) request for fair hearing . name
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