Public Benefits Denial Complaint Generator

Benefits Rights Notice

Due process: Agencies must follow proper procedures before denying benefits. Document communications, missed deadlines, and harm from benefit loss.

Court Information

Forum Type *

County *

Your Information

Your Full Name *

County, State *

Are you a person with a disability?

Disability Details

Describe your disability/medical condition:

What major life activities are limited?

Do you need benefits because of your disability?

Are you a member of any other protected class?

If yes, specify:

Benefit Program Information

What type of benefits were denied/terminated?

If "Other," specify the program:

Government Agencies and Officials

State Agency Name *

Agency Director Name

Caseworker/Official Name

County Department Name

Federal Agency (if applicable)

Your Eligibility for Benefits

Do you meet all eligibility requirements? *

Your Monthly Income

Program Income Limit

Your Total Assets/Resources

Program Asset Limit

Other eligibility factors you meet:

State residency U.S. citizen or qualified immigrant Categorical eligibility (elderly/disabled/pregnant/parent) Work requirements (if applicable) Other program-specific factors

How long have you been receiving these benefits?

The Denial/Termination

What happened to your benefits? *

Date you applied/were reviewed *

Date of denial/termination notice

Documents You Provided

Proof of income (pay stubs, tax returns) Proof of identity and citizenship Medical documentation Proof of residency Household composition info Other required documents

Reason(s) given for denial/termination

Why are those reasons wrong? *

Procedural Violations

What procedural problems occurred?

Didn't provide adequate notice Didn't give required advance notice Notice not in my primary language Didn't explain appeal rights Didn't continue benefits pending appeal Agency missed decision deadline Didn't provide disability accommodations Didn't provide language interpretation Other procedural violations

Describe specific procedural violations:

Did they ignore documentation you provided?

If yes, what documentation was ignored?

Discrimination (If Applicable)

Do you believe you were discriminated against?

If yes, what type of discrimination?

Disability discrimination Race discrimination National origin discrimination Language/accent discrimination Other

Evidence of discrimination:

People with similar situations who got benefits:

Appeals and Administrative Process

Did you request a hearing/appeal? *

If yes, when did you request it?

Status of your appeal:

Problems with the administrative process:

Why shouldn't you have to wait for administrative process?

Immediate and Irreparable Harm

What immediate harm are you suffering? *

Examples of Harm by Benefit Type:

Medical benefits: Can't afford medications, unable to see doctors, health deteriorating
Food benefits: Going hungry, children missing meals, malnutrition
Cash assistance: Can't pay rent (facing eviction), utilities shut off, can't afford basics
Disability benefits: No income while unable to work, depleting savings

Specific consequences you're facing:

Can't afford medical care Can't afford medications Food insecurity/hunger Facing eviction Utilities shut off Accumulating medical/other debt Health getting worse Impact on children/family Other serious consequences

Dollar amount of harm (if calculable):

What will happen if benefits aren't restored immediately?

Systemic Problems (If Applicable)

Are you aware of systemic problems with this agency?

Describe systemic problems:

Others with similar problems:

Legal Disclaimer

This generator provides document drafting assistance and is not legal advice. Consider attorney review before filing.

⚠️ Important Disclaimer

This is an experimental feature, and its products should not be assumed to be ready to file. These generated complaints are meant to serve as a starting point for your pro se litigation. These complaints are generated with AI, and AI can make mistakes. Be sure to check that the facts described here are correct.