The Appeal to State Agency Form (DHS-0033-ENG), provided by the Minnesota Department of Human Services (DHS), allows individuals to contest decisions related to public assistance programs. Submitting this form initiates a fair hearing process to review actions or decisions made by DHS or county agencies.

Key Information:

• Applicable Programs:

  • Medical Assistance (MA)

  • Minnesota Family Investment Program (MFIP)

  • General Assistance (GA)

  • Supplemental Nutrition Assistance Program (SNAP)

  • Child Care Assistance

  • Other DHS-administered programs

• Filing Deadlines:

  • Appeals must be filed within 30 days of receiving the notice of action.

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

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

• Submission Methods:

  • Mail: Send the completed form to:

    rust

    CopyEdit

    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, contact your county worker, a private attorney, or the legal services office serving your county.

Filing an appeal ensures individuals can contest decisions affecting their benefits and services, promoting fairness within Minnesota's human services programs.

For detailed instructions and to access the form, visit:

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