STATE HEARING REQUEST Complete in duplicate. This appeal is ... - communityportal fcdjfs franklincountyohio 2026

1. Click ‘Get Form’ to open the STATE HEARING REQUEST in the editor.
2. Begin by entering your name in the 'Name of Appellant' section. Ensure you include your last, first, and middle names for accurate identification.
3. If known, provide your Assistance Group Number or Social Security Number to help streamline the processing of your request.
4. Fill in your complete street address, including city, state, and zip code. This information is crucial for correspondence regarding your appeal.
5. Indicate the program related to your appeal. This helps clarify the context of your request.
6. Enter the date of action appealed and the date notice was issued. These dates are essential for tracking timelines.
7. Specify the local agency involved in this appeal by writing its name in the designated area.
8. In the 'I want a hearing because' section, clearly state your reasons for requesting a hearing.
9. Sign and date the form at the bottom. Include your telephone number for any follow-up communication.

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