• Section

DHS-7330-ENG   9-20

CHILDREN AND FAMILY SERVICES

P-EBT Help Form

LANGUAGE

English

Español

Af Soomaali

Lus Hmoob

Tiếng Việt

Pусский

Other

OTHER LANGUAGE

FIRST NAME

LAST NAME

PHONE NUMBER

Enter phone number as 123-456-7890

EMAIL ADDRESS (an email address helps with a faster response time)

P-EBT CARD NUMBER

Name and Date of Birth for all applicant children:

Please select the issue you are experiencing:

Appeal P-EBT denial notice I received Haven't received my P-EBT benefits or a denial notice Having trouble activating my P-EBT card (Date of Birth, zip code, address changes) Received a duplicate card, too many benefits, or want to cancel benefits No English Other

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

How did you receive your denial notice?

Email

Mail

CONFIRMATION NUMBER

Enter Student First Name, Student Last Name, Student Date of Birth, School Name and School ID if known

<strong>Upload supporting documentation.</strong> Only PDF, Word, Excel, JPG, GIF, PNG, BMP or text files may be uploaded.

Attach

All P-EBT benefits have been issued for eligible children except for private school children.  If you provided an email address when you applied and did not receive a denial notice, it is likely that the P-EBT card is on its way or was already mailed.  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.

Description of question and/or issue being experienced:

Submit