Dp458 2025

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The document is a Fair Hearing Request Form for individuals with mental retardation seeking home and community-based waiver services from the Department of Public Welfare. It outlines the process for filing an appeal against decisions affecting service eligibility or provision, including instructions for requesting hearings, necessary information, and contact details for assistance. The form allows appellants to specify their hearing preferences and any required accommodations.

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Versions	Form popularity	Fillable & printable
2008	4.8 Satisfied (160 Votes)

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