ADMINISTRATIVE HEARING REQUEST PACKET

COVER LETTER, REQUEST, AND EVIDENCE CHECKLIST

Filing Overview

• Requester: [NAME/ENTITY], Contact: [ADDRESS/EMAIL/PHONE]
• Agency action/date: [DECISION/NOTICE], Docket/Ref: [ID]
• Deadline to request hearing: [DATE] (filed on/before: [DATE])
• Relief: [Hearing de novo / Review on record]; Stay requested: [YES/NO] (see stay section)

Packet Order (suggested)

1) Cover letter (this document).
2) Hearing request form (if agency provides) or request statement (see sample).
3) Copy of challenged notice/decision.
4) Statement of issues and brief factual summary.
5) Evidence/exhibit list (with copies if permitted at this stage).
6) Stay request (optional) with supporting facts (irreparable harm, likelihood of success, equities).
7) Proof of service on agency counsel/official.
8) Any required fee/waiver.

Cover Letter Body (sample)

text
Date: [DATE]

[AGENCY NAME/HEARING OFFICE ADDRESS]

RE: Request for Administrative Hearing – [NAME/ENTITY], Docket/Ref: [ID]

Dear [Hearing Officer/Agency],

Pursuant to the Georgia Administrative Procedure Act (O.C.G.A. Title 50, Chapter 13), we request an administrative hearing to contest the [DECISION/NOTICE] issued on [DATE]. The issues presented include: [LIST ISSUES]. A stay of enforcement is [requested/not requested] pending resolution. Supporting documents and proof of service are enclosed.

Respectfully,
[NAME/TITLE]

Statement of Issues (example)

• Issue 1: [Describe dispute with citation to statute/reg].
• Issue 2: [Describe].
• Issue 3: [Optional].

Evidence/Exhibits (sample categories)

• Notice/decision and related correspondence.
• Factual support: declarations, records, data.
• Legal support: statutes/regs/policy guidance excerpts.
• Mitigation/compliance steps taken.
• Harm evidence (if seeking stay).

Practice Notes

• File within the prescribed deadline; confirm receipt and docketing.
• Follow exhibit formatting and page limits; some agencies require pre-hearing exchange.
• If seeking a stay, include a separate section with harm and merits arguments.
• Track hearing scheduling notices and pre-hearing requirements (witness lists, exhibit exchange, objections).

[// GUIDANCE: For Georgia matters, confirm whether the hearing is before the agency, an ALJ with the Office of State Administrative Hearings (OSAH), and follow the Georgia Administrative Procedure Act and OSAH rules.]