The Appeal to State Agency Form (DHS-0033-ENG) is provided by the Minnesota Department of Human Services (DHS) for individuals who wish to appeal decisions related to various public assistance programs. This form allows a fair hearing for everyone regarding actions or decisions made by DHS or county agencies.

Key Information:

• Programs Applicable for Appeal:

  • Medical Assistance (MA)

  • Minnesota Family Investment Program (MFIP)

  • General Assistance (GA)

  • Supplemental Nutrition Assistance Program (SNAP)

  • Child Care Assistance

  • Other DHS-administered programs

• Time Limits for Filing an Appeal:

  • Generally, appeals must be filed within 30 days of receiving the notice of action.

  • For SNAP (food support), appeals can be filed up to 90 days after the notice.

  • To continue receiving benefits during the appeal process, the appeal must be filed within 10 days of the notice or before the action takes effect.

• Submission Methods:

  • Mail: Send the completed form to: Minnesota Department of Human Services Appeals Office PO Box 64941 St. Paul, MN 55164-0941

  • Fax: (651) 431-7523

  • In-Person: Deliver to the local county human services office or the DHS Appeals Office at 444 Lafayette Rd. N., St. Paul, MN.

• Assistance:

  • For help completing the form or understanding the appeals process, individuals can contact their county worker, a private attorney, or the legal services office serving their county.

Filing an appeal ensures that individuals have the opportunity to contest decisions affecting their benefits and services, promoting fairness and due process within Minnesota's human services programs.

For more detailed instructions and to access the form, visit:

🔗 Appeal to State Agency Form (DHS-0033-ENG)