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WISCONSIN DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F16024 (05/2018)FORESHORE NOTICE OF DISQUALIFICATION Personally identifiable information will be used only for the direct administration
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How to fill out foodshare notice of disqualification

01
To fill out the foodshare notice of disqualification, follow these steps:
02
Begin by reading the notice carefully to understand the reasons for the disqualification.
03
Gather any supporting documents or evidence that may help your case.
04
Fill in your personal information, including your name, address, and contact information.
05
Clearly state the reasons or grounds for the disqualification as mentioned in the notice.
06
Provide any additional explanations or details that can support your case or challenge the disqualification.
07
If required, attach any relevant documents that can strengthen your argument.
08
Review the completed form for any errors or missing information, ensuring everything is accurate and complete.
09
Sign and date the notice of disqualification.
10
Make copies of the filled-out notice and attached documents for your records.
11
Submit the filled-out form along with any supporting documents to the appropriate authority as instructed in the notice.
12
After submitting the notice, it is advisable to follow up with the authority to ensure they have received and processed your request properly.

Who needs foodshare notice of disqualification?

01
Anyone who has been disqualified from receiving foodshare benefits needs the foodshare notice of disqualification.
02
This notice is necessary for individuals who wish to challenge the disqualification decision, provide additional evidence, or request a hearing to review their case.
03
It is important to have the foodshare notice of disqualification in order to protect your rights and ensure fair consideration of your eligibility for foodshare benefits.
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The FoodShare Notice of Disqualification is a formal document that informs recipients that they are no longer eligible to receive FoodShare benefits due to certain circumstances or violations of program rules.
Entities or individuals, such as state agencies or administrators of the FoodShare program, who determine that a participant is ineligible must file a FoodShare Notice of Disqualification.
To fill out a FoodShare Notice of Disqualification, one must provide the participant's details, the reason for disqualification, the effective date, and any necessary supporting information as required by the specific agency's guidelines.
The purpose of the FoodShare Notice of Disqualification is to communicate to recipients about their loss of benefits, the reasons for this loss, and any options they may have for appeal or re-application.
Required information includes the participant's name, address, case number, reason for disqualification, effective date, and information on how to appeal the decision.
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