Hearing Request Public Assistance Form

If you have any questions, call (360) 407-2700 or (800) 583-8271

OAH may take online hearing requests for:

  • Food assistance
  • Temporary Assistance for Needy Families (TANF)
  • Community Options Program Entry System (COPES)
  • Developmental Disabilities Administration (DDD/DDA)
  • Medical Assistance Transfer (MAT)
  • Vocational Rehabilitation (DVR)

If your hearing is about something else, please call (360) 407-2700 or (800) 583-8271.

Note:  If you are being evicted from a medical facility, please fill out the medical hearing request form or call (360) 407-2700 or (800) 583-8271. 

Full Name

Care providers:
If care hours were reduced, please note that a provider is not allowed to request an appeal.
Appeals are only available to the person receiving the benefits.

Are you entering this form for someone else?
Are you representing the appellant?
Are you an attorney?
Representative Name
Representative Address
If you are receiving medical benefits, are they being terminated or reduced?
Are you receiving continued assistance?
Are you requesting your assistance continue at the same level while waiting for your hearing?
Do you need an interpreter for the hearing?
Do you have any concerns that you will be unable to participate in the hearing due to a disability?

Please note that anything submitted past 5:00 PM (Pacific Time) is not considered filed until the following business day.