Indiana Office of Administrative Law Proceedings fax number

Fax destination details

Department

FSSA Appeals (Division of Family Resources)

Purpose

Used to contact the Indiana Office of Administrative Law Proceedings for FSSA appeals (SNAP/TANF/Medicaid). The official fax for documents related to these appeals is 317-232-4412; the number 317-234-3488 is the OALP phone line for FSSA appeals.

Form

SF53932 — Administrative Appeal and Hearing Request (State Form SF53932)

Address

100 N. Senate Avenue, Suite N802, Indianapolis, IN 46204

Voice phone

317-234-3488 (FSSA Appeals) | Toll-free 866-259-3573

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Use this form to file a written administrative appeal. The form asks for name, address, phone, relationship, case number, and which benefits you are appealing (TANF, Medicaid, HIP, Food Stamp, etc.). Food Stamp appeals may also be filed verbally by calling 1-800-403-0864. Mail or fax the form to the FSSA Document Center.

Official form instructions are published as a downloadable file on the organization's website.