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]

Packet Order (suggested)

1) Cover letter (this document).
2) Hearing request form (if agency provides) or request statement.
3) Copy of challenged notice/decision.
4) Statement of issues and brief factual summary.
5) Evidence/exhibit list.
6) Stay request (optional).
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 [CITE AGENCY AUTHORITY], 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.

Respectfully,
[NAME/TITLE]

Statement of Issues (example)

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

Evidence/Exhibits (sample categories)

• Notice/decision and related correspondence.
• Factual support: declarations, records, data.
• Legal support: statutes/regs/policy guidance excerpts.

Practice Notes

• File within the prescribed deadline; confirm receipt and docketing.
• Follow exhibit formatting and page limits.
• Track hearing scheduling notices and pre-hearing requirements.

Indiana-Specific Statutory References

• Indiana Administrative Orders and Procedures Act (AOPA): IC 4-21.5-1-1 et seq.
• Indiana Access to Public Records Act (APRA): IC 5-14-3-1 et seq.
• Contested case procedures: IC 4-21.5-3-1 et seq.
• Judicial review: IC 4-21.5-5-1 et seq.

[// GUIDANCE: For Indiana matters, confirm whether the hearing is before the agency or an Administrative Law Judge under the Indiana AOPA.]