Health & Benefits
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Part of the SNAP Benefits library, sponsored by Winston & Strawn
Request to withdraw an appeal of public benefits decision Blank form
A form to tell the Illinois Dept. of Human Services that you no longer want to appeal a public benefits decision.
Can I use this form?
Use this form if you want to withdraw your appeal of a public benefits decision for one of the following:
- TANF (Temporary Assistance for Needy Families),
- SNAP (Food Stamps),
- AABD (Aid to the Aged, Blind, and Disabled),
- GA (General Assistance),
- Medical, or
- Child Care.
What do I need first?
To complete this form, you will need to know:
- The reason you were appealing the original decision, and
- Why you now want to withdraw the appeal.
If you need help in completing this request, your representative, if you have one, or your caseworker will assist you.
Last full review by a subject matter expert
December 09, 2023
Last revised by staff
December 11, 2023
Worried about doing this on your own? You may be able to get free legal help.
Part of the SNAP Benefits library, sponsored by Winston & Strawn
