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166![Request for a State Fair Hearing to Appeal a Covered California Eligibility Determination If you need help in another language, or would like this form in another language, please refer to the last page of this docum Request for a State Fair Hearing to Appeal a Covered California Eligibility Determination If you need help in another language, or would like this form in another language, please refer to the last page of this docum](https://www.pdfsearch.io/img/c69b5aed1fe4093920bf3e49bf13e1d9.jpg) | Add to Reading ListSource URL: www.coveredca.comLanguage: English - Date: 2015-05-19 17:12:40
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169![Request for a State Fair Hearing to Appeal a Covered California Eligibility Determination If you need help in another language, or would like this form in another language, please refer to the last page of this docum Request for a State Fair Hearing to Appeal a Covered California Eligibility Determination If you need help in another language, or would like this form in another language, please refer to the last page of this docum](https://www.pdfsearch.io/img/f0c084862b3e9f2f02aa5aa195153f7e.jpg) | Add to Reading ListSource URL: www.coveredca.comLanguage: English - Date: 2015-05-19 17:12:40
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