Fair Hearing Request Form DHA-28: Available in English (PDF, 100 KB; exit DHS). Use this form to request a hearing if you don't agree with a decision about your benefits.

Fair Hearing Voluntary Withdrawal Form DHA-17: Available in English (PDF, 10 KB; exit DHS). Use this form to withdraw your request for a hearing.

Self-Employment Income Report (SEIRF) Form F-00107: Available in English (PDF, 54 KB). Use this form to report self-employment income.

Other Links

Agency Directory: Locate the telephone number and address of your local agency.

Caretaker Supplement: Visit the web site for more information. 

Legal Services: Find the name and telephone number of someone who is in your area and can provide you with legal help. You may also go to:

• Legal Action of Wisconsin, Inc. at http://www.legalaction.org/ (exit DHS) or

• The Wisconsin Judicare, Inc. at www.judicare.org/ (exit DHS).

Last Revised: July 29, 2010