Request for SNAP Hearing form

Your name

First NameLast Name

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

County

Address

Street Address

Street Address Line 2 (please include apartment or unit number if applicable)

CityState / Province

Postal / Zip Code

Are you requesting ADA accommodations for your hearing?

Preferred Language

Your CBMS case number

If you are appealing an overpayment claim with more than one liable person, please list any additional liable persons and provide the following information for each: first and last name, mailing address, telephone number, and email address.

Step 1: Choose a type of resolution

There are two levels of dispute resolution:

A dispute resolution conference (DRC) with the local office: A DRC is a meeting with you and any person(s) you choose to have with you and local office staff. This meeting is to explain anything you have questions about and for you to explain your situation. This DRC may resolve the problem and eliminate the need for a fair hearing. If not, you may proceed with a fair hearing.

A state-level fair hearing before a hearing officer: You may have a fair hearing without having a DRC first.

Which level of dispute resolution are you requesting?

Step 2: Attach your SNAP notice

Please upload a copy of the SNAP notice you disagree with (if applicable) and complete all of the following steps within 90 days of the notice.

Step 3: Reason for disagreement

Explain why you disagree with this SNAP decision.

Step 4: Continue or stop benefits

You must request continuation of benefits prior to the date the action is to be taken. If you were denied SNAP or if your SNAP certification period is over, you are not eligible for continuation of SNAP benefits.

You have two choices:

1. You may choose to continue receiving the SNAP benefits you were receiving until your hearing decision is made or your current recertification period ends, whichever comes first. If the hearing officer agrees with the local office's action, all adult members of your SNAP household will be responsible for repaying the SNAP benefits received between the time the local office took action and the discontinuation of your continued benefit. To make sure your benefits continue, request a hearing as soon as possible.

2. You may choose to not continue the SNAP benefits you were receiving. You will continue to receive your new benefit amount or no benefits, depending on the results of the action you are appealing. If the hearing officer does not agree with the local office's action, you will receive any SNAP benefits you are eligible for after the decision has been made.

Do you want to continue or stop SNAP benefits until your hearing decision has been made?

Need free legal help?

You may be able to get free legal help from Colorado Legal Services by calling 303.837.1313. Visit the Colorado Legal Services website for more information.

USDA Non-Discrimination Statement

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the agency (state or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form (also available at any USDA office, by calling (866) 632-9992, or by writing a letter to the USDA). The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to:

Mail:
U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Ave SW, Mail Stop 9410, Washington, DC 20250-9410.

Email: program.intake@usda.gov

This institution is an equal opportunity provider.

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