ADMINISTRATIVE HEARING REQUEST PACKET

Filing Overview

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

Packet Order (suggested)

1) Cover letter
2) Hearing request form 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
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]. Supporting documents and proof of service are enclosed.

Respectfully,
[NAME/TITLE]

Practice Notes

• For Michigan matters, confirm whether the hearing is before the agency or the Michigan Office of Administrative Hearings and Rules (MOAHR), and follow the Michigan Administrative Procedures Act (MCLA 24.201 et seq.).