Administrative Hearing Request Packet

ADMINISTRATIVE HEARING REQUEST PACKET — ARIZONA

Important scope

This packet is a drafting aid, not a universal Arizona appeal form and not a substitute for the instructions in an agency notice.

A.R.S. § 41-1092.03 supplies a request procedure for an appealable agency action or contested case when that article applies. A.R.S. § 41-1092.02 excludes or specially treats numerous agencies and matters. Other laws may create a different hearing right, deadline, form, recipient, or route. Do not assume that a matter goes to the Arizona Office of Administrative Hearings (OAH), that every request has a 30-day deadline, or that an initial request should be sent directly to OAH.

Before drafting, obtain the complete notice and identify all of the following:

If the notice is incomplete, unclear, or close to expiration, obtain Arizona legal advice promptly. Do not wait for an informal response from agency staff before protecting a stated deadline.

1. Route and coverage screen

A. Does the uniform article apply?

Review A.R.S. § 41-1092.02 and the agency-specific law before using the statutory form in this packet.

The exclusions in § 41-1092.02 include matters of the Industrial Commission of Arizona, Arizona Corporation Commission, State Personnel Board, and several other identified agencies. The statute also excludes or limits application for specified matters involving the Departments of Transportation, Economic Security, Revenue, and Child Safety, among others. Tax, unemployment, public-assistance, workers' compensation, transportation, education, and professional-regulatory matters may therefore use different statutes and routes.

☐ Section 41-1092.02 reviewed against the exact agency and matter

☐ Agency-specific statute, rule, current form, and notice reviewed

☐ Uniform article applies without an applicable exclusion or displacement

☐ If the uniform article does not apply, the correct specialized route is documented below

Specialized route and authority:

[________________________________]

[________________________________]

B. Is § 41-1092.03 the request procedure?

Section 41-1092.03(E) says its request procedure does not apply to a contested case when the agency initiates the hearing under other law and not in response to another party's request, or when the agency is not otherwise required to offer an administrative hearing before determining an applicant's license rights. Confirm that neither condition displaces this request form.

Controlling request provision: [________________________________]

Reason it applies: [________________________________]

C. Deadline and recipient

When § 41-1092.03(B) controls, the party files the notice of appeal or hearing request with the agency within 30 days after receiving the notice described in subsection A. The request is not initially filed with OAH under that subsection. Subsection D permits an agency head to accept an untimely request for good cause, but it does not guarantee acceptance.

Do not use that 30-day period for an excluded or specialized matter unless its controlling law or notice independently confirms it.

2. Cover letter to the correct recipient

[__/__/____]

VIA: [method authorized by the notice or governing law: ________________________________]

[________________________________]

[Agency, division, board, or commission]

[________________________________]

[Address or approved electronic destination]

Re: Request for administrative hearing

Affected party: [________________________________]

Agency reference number: [________________________________]

Notice date: [__/__/____]

Date received: [__/__/____]

Dear [________________________________]:

The affected party requests the hearing authorized by [exact statute, rule, notice provision, or program authority: ________________________________] concerning the action described in the attached notice.

The request is timely because [state the controlling period, trigger, and calculation: ________________________________].

The enclosed request identifies the disputed action, reasons for the request, questions of law if applicable, and supporting documentation. Please provide written confirmation of receipt and any assigned agency or OAH number.

Respectfully submitted,

Signature: ________________________________

Name: [________________________________]

Capacity: ☐ Affected party ☐ Arizona attorney ☐ Other authorized capacity: [________________]

Arizona Bar No., if applicable: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

Enclosures: [________________________________]

3. Notice of appeal or request for hearing

Use this section only if the governing notice and law permit a written request in this form. Use a mandatory agency form instead when required.

A. Party, agency, and action

Affected party's legal name: [________________________________]

Mailing address: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

Representative and authority to act, if applicable: [________________________________]

Agency and division: [________________________________]

Agency reference number: [________________________________]

Action challenged: [________________________________]

Date of notice: [__/__/____]

Date notice was received: [__/__/____]

Effective date of action: [__/__/____]

B. Authority, deadline, and route

Source creating the hearing right: [________________________________]

Request procedure: ☐ A.R.S. § 41-1092.03 ☐ Other: [________________]

Exact filing deadline: [________________________________]

Trigger for deadline: [________________________________]

Deadline calculation: [________________________________]

Required recipient: [________________________________]

Required form or contents: [________________________________]

Permitted filing method used: [________________________________]

Required internal review completed: ☐ Yes ☐ No ☐ Not applicable

Explanation: [________________________________]

C. Request and reasons

The affected party requests an administrative hearing concerning the action identified above.

Concise statement of the reasons for the appeal or hearing request:

1. [________________________________]

2. [________________________________]

3. [________________________________]

Agency findings, allegations, or conclusions disputed:

1. [________________________________]

2. [________________________________]

3. [________________________________]

D. Questions of law, if applicable

When § 41-1092.03(B) controls, provide detailed and complete information regarding all questions of law that form the basis for the request.

1. Legal question and supporting authority: [________________________________]

Application to this matter: [________________________________]

2. Legal question and supporting authority: [________________________________]

Application to this matter: [________________________________]

3. Legal question and supporting authority: [________________________________]

Application to this matter: [________________________________]

E. Adversely affected party, if applicable

Section 41-1092.03(B) allows a party who will be adversely affected and who exercised a legally provided right to comment to file on grounds limited to issues raised in that party's comments.

☐ Not applicable; the filing party's own legal rights, duties, or privileges were determined

☐ The filing party claims adversely affected-party status

Law providing the right to comment: [________________________________]

Date and method of comment: [________________________________]

How the party will be adversely affected: [________________________________]

Issue raised in the comment and preserved here: [________________________________]

F. Relief requested

☐ Withdraw or reverse the challenged action

☐ Modify the action as follows: [________________________________]

☐ Remand for further agency proceedings

☐ Issue, renew, restore, or continue the identified license, permit, benefit, or status, if authorized: [________________________________]

☐ Other relief authorized by the governing law: [________________________________]

G. Late-request explanation, if needed

Complete this section only if the filing is late and the controlling law permits relief. Under § 41-1092.03(D), an agency head may accept a late request if good cause is shown.

Length of delay: [________________________________]

Specific facts supporting good cause:

[________________________________]

[________________________________]

Supporting documents: [________________________________]

Requested ruling: [________________________________]

H. Interim relief

Do not use a generic four-factor test. A hearing request does not automatically establish a stay, continued benefits, or other interim relief. Identify the separate authority, recipient, standard, deadline, and required security, if any.

Interim relief requested: [________________________________]

Authority: [________________________________]

Authorized decision-maker: [________________________________]

Required elements and facts:

[________________________________]

[________________________________]

I. Signature

I certify that the factual statements in this request are accurate to the best of my knowledge and that the attached materials are true copies unless otherwise identified.

Signature: ________________________________

Name: [________________________________]

Date: [__/__/____]

4. Supporting-document and filing checklist

Section 41-1092.03(B), when applicable, requires all relevant supporting documentation.

☐ Complete agency notice attached

☐ Mandatory agency form attached or used instead of this packet

☐ All relevant supporting documentation attached

☐ Questions of law completed if applicable

☐ Adversely affected-party explanation and prior comments attached if applicable

☐ Representative authorization attached if required

☐ Internal-review decision attached if required

☐ Separate interim-relief request attached only if authorized

☐ Confidential or identifying information handled under the governing rules

☐ Request signed

☐ Correct recipient, destination, and method rechecked against the live notice

☐ Copy retained exactly as submitted

Transmission record

5. After the request is submitted

When § 41-1092.03 applies, subsection C directs the agency to notify OAH, after which OAH schedules the hearing, subject to the statutory exception stated there. Preserve the agency's receipt confirmation and wait for the case-specific notice rather than sending later case filings to a guessed destination.

Case-opening record

Filing after an OAH docket opens

A.A.C. R2-19-108 applies to documents filed with OAH. It requires the agency caption and OAH docket number, a signature, service on all parties, and specified service information. The current OAH electronic-submission page may be used for written communication and filings in an open OAH case, subject to the case-specific notice and order. The filing party remains responsible for serving the other parties.

Do not use OAH's electronic-submission system as a substitute for the initial agency filing unless controlling authority expressly directs that route.

Hearing format and preparation

The current OAH home page states that hearings are in person at OAH in Phoenix unless the Notice of Hearing or the administrative law judge provides otherwise. It also states that a party or witness seeking video or telephone appearance may request permission no later than seven calendar days before the hearing. Follow the actual notice and any later order.

Prepare to:

☐ Read every page of the Notice of Hearing and scheduling order

☐ Calendar all motion, witness, exhibit, subpoena, and accommodation deadlines

☐ Identify the governing burden and standard from the agency-specific law

☐ Organize admissible exhibits and witness testimony by disputed issue

☐ Serve every filed document as required

☐ Request an interpreter, disability accommodation, continuance, or remote appearance by the stated deadline

☐ Preserve proof of filing and service

Do not assume civil discovery is available. Use only discovery, subpoena, disclosure, and exchange procedures authorized by the controlling statute, rule, Notice of Hearing, or administrative law judge.

6. Decision and review screen

Do not calculate rehearing or judicial-review deadlines from this packet. When a decision arrives, identify whether it is an administrative law judge decision, agency final decision, rehearing ruling, or another document, then use the decision's notice and the law governing that agency.

7. Current official sources

• Arizona Legislature — A.R.S. § 41-1092.02
• Arizona Legislature — A.R.S. § 41-1092.03
• Arizona OAH — procedural rules and statutory links
• Arizona OAH — A.A.C. R2-19-108
• Arizona OAH — electronic submission information
• Arizona OAH — hearing-format notice
• Arizona OAH — current Phoenix location and general inquiry information

This template must be reviewed and customized by a qualified Arizona attorney. Confirm the live agency notice, current official form, deadline, recipient, filing method, specialized rules, and review route before use.