Iowa Department of Human Services

Appeal and Request for Hearing

Who is Appeal For?

What are You Appealing?

Check the programs you want to appeal

Yes  No
Yes  No
Yes  No
Yes  No
If someone will be helping you with your appeal, write that person's name and address below.
You do not have to list someone here. (If you are appealing child abuse or adult abuse, then only an attorney can help with your appeal.)


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