|You Have the Right to Appeal
You, or the person helping you,
may request an appeal hearing if you do not agree with any action taken on your case.
For Food Assistance, you can appeal in person or by telephone. For all other programs,
you must appeal in writing. To appeal in writing do one of the following:
Fill out an appeal electronically at https://dhssecure.dhs.state.ia.us/forms/ , or
Write a letter telling us why you think a decision is wrong, or
Fill out an Appeal and Request for Hearing form. You can get this form at your county DHS office.
Send or take your appeal to the Department of Human Services, Appeals Section, 5th Floor, 1305 E Walnut
Street, Des Moines, Iowa 50319-0114. If you need help filing an appeal, ask your county DHS office.
You can represent yourself. Or, you can have a friend, relative, lawyer or someone else
act on your behalf.
You may contact your county DHS office about legal services.
You may have to pay for these legal services. If you do, your payment will be based on your income.
You may also call Iowa Legal Aid at (800) 532-1275. If you live in Polk County, call (515) 243-1193.
You Will Not Be Discriminated Against
It is the policy of the Iowa
Department of Human Services (DHS) to provide equal treatment in employment and provision of services
to applicants, employees and clients without regard to race, color, national origin, sex,
sexual orientation, gender identity, religion, age, disability, political belief or veteran status.
If you feel DHS has discriminated against or harassed you, please send a letter detailing
your complaint to:
Iowa Department of Human Services, Hoover Building,
5th Floor – Policy Bureau, 1305 E Walnut, Des Moines IA 50319-0114 or via email
(Food Assistance only) USDA – Director,
Office of Adjudication, 1400 Independence Ave SW, Washington DC 20250-9410,
or call 1-866-632-9992 voice. Individuals who are hearing impaired or have speech disabilities
may contact USDA through the Federal Relay Service at 800-877-8339; or 800-845-6136 (Spanish).
We Check What You Tell Us
The information you give us may be checked by federal, state and local officials to make sure it is true.
Things we might check are any listed person’s: Social Security Number, job and pay, bank account
amount, alien status, and amounts received from other sources like Social Security or unemployment.
If any information you give us is not correct, we may deny your application.
We may check records from other states to see if any person in your household can get benefits in Iowa.
This may be because a person was disqualified from a program in another state.
We check and use computer systems like the state Income and Eligibility Verification System.
If something you told us is different from what the computer system tells us, we will
check to find out what is correct. We might check your information by contacting your employer,
your bank or other people. To do this kind of checking with your employer, bank, or other people,
we will ask you first.
Things You Need to Know:
DHS may give your answers to law enforcement officials to catch persons fleeing to
avoid the law.
The Quality Control unit or Investigations unit may review your case.
They may contact other people or organizations to get proof of your information. By signing this
application, you give permission to release confidential information to the Quality Control unit
or Investigations unit. You must cooperate with them to keep your benefits.
You will have to pay back any benefits you got or that was paid to a third party on your behalf
for which you were not eligible.
Section 1128B of the Social Security Act provides
federal penalties for fraudulent acts and false reporting in connection with these programs.
Anyone who gets, tries to get, or helps any other person get assistance to which they are not
entitled, is guilty of violating the laws of the state of Iowa. This includes, but is not limited to,
Iowa Code Chapters 239B, 243, 249, and 249A.
Your expenses may be used to figure the amount
of assistance you get. You may have expenses included in your benefit calculation by reporting and
giving proof of your expenses. If you do not report or give proof of your expenses, you choose not
to claim the expense. You can report and give proof later, and the expense can be used for future months.
Comm. 233 will be given to you at your interview. It will tell you about any additional
rights and responsibilities not covered with this application.
Rules of the Food Assistance Program
Follow these rules:
Don’t hide or give wrong information on purpose to get Food Assistance benefits.
Don’t use Food Assistance benefits to buy non-food items like alcohol or tobacco.
Don’t trade, sell or give away Food Assistance benefits. Don’t
use someone else’s Food Assistance benefits for yourself. Don’t
fail to report if your household goes over its income limit.
If you get Food Assistance,
your worker will tell you what your household’s income limit is. If your household’s income goes over
your limit in any month you must tell us by the 10th day of the next month. If you don’t tell us on time,
you might have to pay back the benefits.
Penalties of the Food Assistance Program
Anyone who breaks the above rules:
May not get Food Assistance benefits for
1 year for the first time, 2 years for the second time, and forever for the third time;
May be fined up to $250,000 or jailed up to 20 years or both; and May be kept
off Food Assistance for an additional 18 months, if court ordered.
If a court finds you
guilty of buying, selling, or trading more than $500 in Food Assistance benefits, you will
lose benefits forever.
If a court finds you guilty of trading Food Assistance
benefits for firearms, ammunition or explosives, you will lose benefits forever.
If a court finds you guilty of trading Food Assistance benefits for controlled substances,
you will lose benefits for two years the first time and forever the second time.
You will not get Food Assistance for 10 years if you are found guilty of getting or trying
to get Food Assistance in more than one household at a time. This penalty happens if you
give wrong information about who you are or where you live.
information on purpose may result in us taking legal action against you, either criminal or civil.
It might also mean we reduce your benefits or take money back from you.
Things You Need to Know:
Households eligible for Food Assistance may get a notice
that they are eligible for the “Promoting Awareness of the Benefits of a Healthy Marriage” program
and a pamphlet listing those benefits. By giving this information, DHS can use different rules that
may help you get Food Assistance.
If you have a Food Assistance overpayment, DHS will
give your answers to federal and state agencies as well as private claims collection agencies,
to collect the overpayment.
The Food Assistance office may contact other people or
organizations to get proof of your information.
By having signed this application,
you agree that all members of your household will follow the work and training rules.
Family Investment Program (FIP) or Refugee Cash Assistance
Things You Need to Know:
Within 10 days of the date the change
happens, you must tell DHS about changes, such as: Income, when it starts or stops,
including getting an inheritance or a one-time payment of past due child support Resources
Someone moving in or out of your home Mailing or living
address Receipt of a Social Security Number
Change of school attendance of
If your application for FIP or Refugee Cash
Assistance is approved, your Food Assistance may go down or stop.
If you are approved for FIP,
you will be registered with the PROMISE JOBS program. You agree that all members of your household
who must cooperate with PROMISE JOBS will do so.
Talk with your worker if you feel you have a reason
not to cooperate.
If you choose not to take part in PROMISE JOBS, your FIP benefits will
While you get FIP, you give up your rights to child support for the months
you are on FIP. The state of Iowa will keep your child support to pay back the money you get from FIP.
Using Your Electronic Access Card (EAC) on or after 02-01-2014
You cannot access your cash benefits with your EAC card at a:
store or any place that mainly sells liquor, Casino or other gambling or gaming establishment,
or Business which provides adult-oriented entertainment in which performers disrobe or perform
in an unclothed state (such as a strip club).
If the department determines
that you have accessed your cash benefits with your EAC card at one of the above places, you:
Will have committed fraud,
Have to repay the amount of cash accessed at the
location, and Your family will not get cash benefits for 3 months with the first misuse and
6 months for each additional misuse.
Penalty for Getting FIP in More Than One
You will not get FIP for 10 years if you are found guilty of getting or
trying to get FIP in more than one state at a time. This penalty happens if you give wrong information
about where you live.
Child Care Assistance (CCA)
Things You Need to Know:
Within 10 days of the date the change happens, you must tell DHS about changes, such as:
Income, including a change
in your hourly rate and when income starts or stops Work hours Mailing or living address Class schedule
Someone moving in or out of the house Change in child care provider
All material Copyright © State of Iowa, 2012