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1077 Chapter 7:Worker guides • Section 2: SNAP worker guides (07/2026) Form # Title/Use Paper Forms server PDF fill in MSC 284A Overpayment/Overissuance Change Report Form forwarded to the Overpayment Recovery Unit when the amount of a previously written overpayment is adjusted. None X X MSC 284BP Notice of Overpayment and Planned Action for Provider Overpayments Notice to the individual prior to collection beginning on an overpayment. None

X DHS 362 Notice of Restoration of Benefits Notice to the individual when benefits are issued to make up for an ODHS|OHA-caused underissuance of benefits. X X MSC 371 Overpayment and Fraud Investigation Referral Used to refer a case to the Investigator when information has been received through a community complaint or other source indicating that eligibility is questionable. X DHS 411 Missed Appointment Postcard Postcard sent to appicants when they miss their first intake appointment. X X DHS 414 Notice of Transfer Notice of new branch office, sent to the individual when the case in transferred to a different office or the individual has moved to a new service area. X X DHS 415Z Enumeration Request Used to verify that an individual has applied for a new or duplicate Social Security Number, in order to meet the enumeration requirement for eligibility. X X MSC 443 Administrative Hearing Request Form the individual may use to put a request for a fair hearing into writing (must be completed by ODHS|OHA if it is a verbal request). X X X MSC 457D Voluntary Agreement to Take Action on Case Notice signed by the individual giving ODHS|OHA permission to take action on benefits immediately, which waives the right to a timely notice. Also used to withdraw an application request. Also used to take benefits out of EBT account to avoid an overpayment. X X X DHS 475 Job Search Verification Form used by individuals performing job search to verify employer contacts. X X