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Print Form Clear Form Administrative Hearing Request Department of Human Services (DHS) or Oregon Health Authority (OHA) completes this part Date of notice: / Date Received by DHS or OHA: (Request

How to fill out administrative hearing request

How to Fill Out an Administrative Hearing Request:

1. Gather all necessary information and documents related to the matter being contested. This may include any notices or correspondence received, relevant contracts or agreements, and any supporting evidence or witnesses.
2. Carefully read the instructions provided with the administrative hearing request form. These instructions will guide you on the specific information and sections that need to be completed.
3. Start by providing your personal information, such as your name, address, contact details, and any identification numbers or references relevant to the case.
4. Clearly state the reason for the administrative hearing request. Explain the issue or problem you are facing and why you believe the decision or action being contested is incorrect or unjust.
5. Include any key dates, timelines, or reference numbers that are relevant to the case. This will help the administrative body to accurately identify and assess your request.
6. Provide a detailed explanation of the facts and circumstances surrounding the issue. Be concise yet comprehensive, ensuring that all relevant information is included.
7. If applicable, outline any attempts you have made to resolve the matter outside of the administrative hearing process. This can include any previous discussions, negotiations, or formal complaints that have been made.
8. Attach any supporting documentation that strengthens your case. This can include contracts, invoices, receipts, photographs, witness statements, expert opinions, or any other evidence that is relevant to your claim.
9. Review your administrative hearing request form for completeness and accuracy. Make sure that you have signed and dated the form, and that all necessary attachments are included.
10. Keep a copy of the completed administrative hearing request form and all supporting documents for your records.

Who needs an Administrative Hearing Request:

1. Individuals or entities who feel aggrieved by a decision or action taken by a government agency, regulatory body, or administrative authority.
2. Those seeking to challenge a denial, revocation, or suspension of a license, permit, or certification.
3. Individuals or businesses disputing a decision regarding financial penalties, fines, or sanctions imposed by an administrative body.
4. Parties involved in a disagreement or dispute with a government agency, regulatory body, or administrative authority that can only be resolved through a formal hearing process.
5. Those who believe that their rights, privileges, or interests have been violated or adversely affected by an administrative decision and want the opportunity to present their case and seek a favorable resolution.

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What is administrative hearing request?

Administrative hearing request is a formal request made to a government agency or administrative body to review a decision or take action on a particular matter.

Who is required to file administrative hearing request?

Any individual or entity that is directly affected by a decision or action of a government agency or administrative body may be required to file an administrative hearing request.

How to fill out administrative hearing request?

An administrative hearing request can typically be filled out by submitting a written request detailing the reasons for the request, supporting documents, contact information, and any other required information specified by the agency or body.

What is the purpose of administrative hearing request?

The purpose of an administrative hearing request is to seek a review of a decision or action taken by a government agency or administrative body, and potentially reverse or modify the decision.

What information must be reported on administrative hearing request?

The information required on an administrative hearing request may include details about the decision being challenged, reasons for the challenge, supporting evidence or documents, contact information, and any other relevant information specified by the agency or body.