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 [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. 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).
- For Kentucky matters, confirm whether the hearing is before the agency or an ALJ, and follow the specific procedural rules under the Kentucky Administrative Procedures Act (KRS Chapter 13B).