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DHS-7330-ENG   10-20

CHILDREN AND FAMILY SERVICES

P-EBT Help Form

Use the denial notice you received to complete the information below. If you do not attach proof now, you may miss the appeal deadline.

    All P-EBT benefits have been issued for eligible children and all P-EBT denials have been sent either by email or mail. Please enter your current address in the Description box below to help us determine if a replacement card is necessary.

    Please enter your full name, date of birth, and current address in the Description box below.