ND RENT HELP ONLINE APPEAL

NORTH DAKOTA DEPARTMENT OF HEALTH AND HUMAN SERVICES
LEGAL DIVISION
SFN 62098 (5-2023)

This process is available to appeal an adverse determination made by the Department of Health and Human Services.
Click here to review the Right to Hearing
Rights to a Hearing confirmation *
By checking this box you are confirming you have read and understand the "Rights to a Hearing " information.
I am appealing a decision made by ND Rent Help.
APPEAL OF: *
Applicant Landlord
Name First Last
Phone - ### - ### ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
STEP 1: ATTACH THE NOTICE THAT YOU ARE CONTESTING.
* Accepted file types include pdf, tif, tiff, jpg, jpeg
* Max of 5 files
* Each file must not exceed 10 MB in size

Attach Files Attach Files
STEP 2: EXPLAIN THE ERROR THAT YOU CLAIM WAS MADE. *
Maximum of 1300 characters allowed. Currently Entered: 0 characters.
Check here if you need additional space to explain the error
Maximum of 1300 characters allowed. Currently Entered: 0 characters.
STEP 3: Complete this part only if you will have someone such as an attorney, relative or other person of your choosing, assist you in your appeal.
By checking this box I am authorizing the person listed below to assist me with my Appeal.
Authorized Person Information:
Name First Last
Phone - ### - ### ####
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
STEP 4: SIGN AND DATE
By signing my name, I attest that I have read and understand my rights.
Typed Signature *
Date *