Dmap 3302-2026

1. Click ‘Get Form’ to open the dmap 3302 in the editor.
2. Begin by entering your Client ID, Case Number, Branch Number, Worker ID, and Program Number at the top of the form.
3. On pages 1 through 3, fill in your personal information including Member Name, Address, City, Phone Number, Language Preference, Member ID#, State, ZIP Code, and Date of Birth.
4. Indicate your appeal preferences by checking the appropriate boxes regarding your desire for an Appeal or Hearing.
5. Provide the Date of Notice for which you are requesting an Appeal and/or Hearing as shown on your Notice of Action.
6. If applicable, check whether you want to continue receiving services during the Appeal process and provide details if you need an expedited request.
7. Complete the signature section at the end of the form. If someone assisted you in filling it out, ensure they sign as well.

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