How to Complete and Submit the Pennsylvania Fair Hearing Request Form

To appeal a decision about your SNAP, Medical Assistance, cash assistance, child care, or other DHS benefits in Pennsylvania, complete the Pennsylvania fair hearing request form (PA/FS 162) and submit it to the County Assistance Office that sent your notice. You generally have 30 days from the date on the notice to file, or 90 days for SNAP. You can also appeal by writing a signed letter instead of using the form, and SNAP appeals can be made orally by phone.1Department of Human Services. Request a Hearing or Appeal from DHS

Check Your Filing Deadline First

The deadline is the first thing to confirm, because a late appeal is dismissed without a hearing. The clock starts on the date printed on the notice from your County Assistance Office.2Pennsylvania Code and Bulletin. 55 Pa Code 275.3 – Requirements

  • Cash assistance, Medical Assistance, or social services: 30 days from the date of the written notice.
  • SNAP (food stamps): 90 days from the date of the agency action or loss of benefits. You can also dispute your current benefit level at any time during your certification period.
  • No written notice received: 60 days from the action or failure to act.
  • Agency didn’t tell you about your appeal rights: up to 6 months, if you file a written affidavit stating that you didn’t know about the right or believed the problem was being resolved, that you believe the office made an error, and that you’re filing in good faith.

If you want your benefits to continue uninterrupted while the appeal is pending, file before the effective date of the change listed on the notice. This matters most for Medical Assistance and cash assistance, where reinstating benefits after they stop is harder than keeping them running.

What to Put on the Form

The PA/FS 162 is available from your County Assistance Office and on the DHS website. A plain letter works too, as long as it is signed and gives the agency enough information to identify your case and the decision you want reviewed. For SNAP only, you can skip writing entirely and file the appeal orally by calling the office that sent your notice.1Department of Human Services. Request a Hearing or Appeal from DHS

Whether you use the form or a letter, include:

  • Your full name and a phone number where you can be reached during business hours.
  • Your case number, copied exactly from your most recent DHS correspondence.
  • The date on the notice you’re appealing, which shows your request is within the deadline.
  • The program involved: SNAP, Medical Assistance, cash assistance, child care, or another service.
  • What you’re disputing and why, in specific terms. “My notice says my household income is $2,400 per month, but my actual income is $1,800 — I’ve attached my last two pay stubs” gives the hearing officer something to work with. “I disagree with the decision” does not.

If you need an interpreter or a disability accommodation at the hearing, note that on the form or in your letter. Flagging it now prevents scheduling delays later.

Where and How to Send It

Send your appeal to the office that took the action against you. The address is on your notice. If the notice directs you to send it elsewhere, follow those instructions.3Pennsylvania Department of Human Services. Hearings and Appeals This trips people up: the Bureau of Hearings and Appeals (BHA) runs the hearing itself, but the initial appeal goes to the local County Assistance Office or whichever agency made the decision.

You have four ways to deliver it:

  • Mail. Use certified mail with return receipt if you have more than a few days before the deadline. The receipt proves when the office received your appeal.
  • Fax. The BHA fax numbers are 717-772-2769 and 717-346-1959. For your local office, use the fax number printed on the notice. Keep the confirmation page.
  • Hand delivery. Walk it into the County Assistance Office and ask the clerk to date-stamp a copy for you.
  • Online. The PA/FS 162 references an online option. Check the DHS hearings and appeals page or the web address on your notice for the current portal.

Keep a copy of everything you send. If there’s ever a dispute about whether you filed on time, your date-stamped copy, fax confirmation, or certified mail receipt is the proof.

What You Can Appeal

Under 55 Pa. Code § 275.1, you can appeal:

  • A denial, suspension, or discontinuance of benefits, in whole or in part.
  • A change in your benefit amount you believe is wrong.
  • Service program disputes, including being excluded from a service, having your preferred service option ignored, or being told to participate in a program you believe doesn’t apply to you.
  • An overpayment claim you disagree with.
  • Unreasonable delay in processing your application or adjusting your payment.
  • A denied request to correct or remove information in your case file.

A few things are outside this right. You cannot appeal a decision to refer your case for fraud prosecution, and you generally cannot appeal automatic benefit adjustments that apply to all recipients by law, unless the agency made a math error in applying the adjustment to your case. SNAP is an exception to that limit: you can always appeal a SNAP decision regardless of the issue.4Pennsylvania Code and Bulletin. Pennsylvania Code Chapter 275 – Appeal and Fair Hearing

What Happens After You File

Once BHA logs your appeal, you’ll get a scheduling order with the date, time, and format of the hearing. You must receive at least 10 days’ notice before the hearing date.5Pennsylvania Code and Bulletin. Pennsylvania Code Chapter 275 – Appeal and Fair Hearing – Section 275.4 The state must issue a final decision within 60 days of your appeal for SNAP, and 90 days for cash assistance, Medical Assistance, or social services.

Most hearings are held by telephone. In-person hearings are more common in the Philadelphia area. If you prefer to appear in person, say so when you receive the scheduling order or note it on your appeal form.6Department of Human Services. Hearing and Appeals Process You have the right to bring a representative, including an attorney or a legal aid advocate.7Pennsylvania Department of Human Services. Supplemental Handbook – 870.2 Requesting a Fair Hearing Pennsylvania Legal Aid Network handles benefits cases and can represent qualifying applicants at no cost.

Keep your mailing address current with DHS throughout the process. If you move and miss the scheduling order, the hearing can go forward without you.