Free FoodShare Wisconsin Application Registration, HCF 16019BR - Wisconsin


File Size: 690.7 kB
Pages: 16
Date: September 12, 2005
File Format: PDF
State: Wisconsin
Category: Health Care
Author: dhfs
Word Count: 724 Words, 12,187 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://dhs.wisconsin.gov/forms/F1/F16019BR.pdf

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STATE OF WISCONSIN DEPARTMENT OF HEALTH AND FAMILY SERVICES Division of Health Care Financing HCF16019BR (Rev. 12/04)

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W-2 FoodShare Wisconsin - . W-2 , FoodShare. United States Department of Agriculture « », ( /) , , , , , . , : USDA Director, Office of Civil Rights Room 326-W, Whitten Building 1400 Independence Avenue, S.W., Washington D.C. 20250-9410 : (202) 720-5964 ( ) USDA « » , . , : Department of Health and Family Services (DHFS) Affirmative Action and Civil Rights Compliance Office 1 W. Wilson, Room 555 Madison, WI 53707-7850 : (8) 266-9372; (608) 266-2555 () : (608) 267-2147 DHFS -, . (608) 266-9372 (608) 266-2555 (). FAIR HEARING Fair Hearing, , . Fair Hearing, : Department of Administration Division of Hearings and Appeals P.O. Box 7875 Madison, WI 53707-7875 : (608) 266-7709

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