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Connecticut Department of Public Health WIC Program REQUEST FOR A FAIR HEARING ___ NAME WIC ID or HOBNAILING ADDRESS CITY/iPhone #I AM REQUESTING A HEARING AS PROVIDED IN THE WIC PROGRAM REGULATIONS.

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How to fill out wic-106-01-request-for-fair-hearing-formpdf - ctgov

01

Download the WIC-106-01 Request for Fair Hearing Form in PDF format from ct.gov website.

02

Fill out the form completely with accurate information.

03

Make sure to sign and date the form before submitting it.

04

Submit the filled-out form to the appropriate address as indicated on the form or on the ct.gov website.

05

Await confirmation of receipt and further instructions regarding the fair hearing process.

Who needs wic-106-01-request-for-fair-hearing-formpdf - ctgov?

01

Individuals who feel they have been unfairly denied benefits or services through the WIC program and wish to appeal the decision.

02

Anyone who wants to request a fair hearing to challenge a decision made by the Connecticut WIC program.

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What is wic-106-01-request-for-fair-hearing-formpdf - ctgov?

This form is a request for a fair hearing related to WIC benefits.

Who is required to file wic-106-01-request-for-fair-hearing-formpdf - ctgov?

Anyone who wants to appeal a decision related to their WIC benefits may be required to file this form.

How to fill out wic-106-01-request-for-fair-hearing-formpdf - ctgov?

The form should be filled out with all relevant information about the decision being appealed.

What is the purpose of wic-106-01-request-for-fair-hearing-formpdf - ctgov?

The purpose of this form is to request a fair hearing to appeal a decision related to WIC benefits.

What information must be reported on wic-106-01-request-for-fair-hearing-formpdf - ctgov?

The form may require information such as personal details, WIC case number, reason for appeal, and supporting documents.

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