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87 | P a g e October 25 RESPONSIBILITY ADMINISTRATIVE REVIEW PROCESS a) Send the green copy of Form DHPPS-LS-007 to the HCSD Reviewer or Designee. b) Send the white copy of the Form DPHHS-LS-7) to the Hearing Officer. Hearing Officer 8. If the Claimant is still dissatisfied, the Hearing Officer sets the time and place of the Fair Hearing and notifies the claimant.

REDUCED COPY OF REQUEST FOR A FAIR HEARING FORM

[DATE] CERTIFIED MAIL John Doe 123 Spring Street Helena, MT

Dear Mr. Doe: Your request for a Fair Hearing regarding the denial of fuel assistance by the (HRDC name) has been received in this office. I would like to provide you with an opportunity to discuss this matter with the Director in your area, XXX. You may engage legal counsel if you so desire, but this is not necessary. However, should you wish an attorney to represent you, the Montana Legal Services Association has an office serving your area, which is located at 616 Helena Avenue, Suite 100, Helena, Montana.