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 North Carolina matters, confirm whether the hearing is before the agency or the Office of Administrative Hearings (OAH), and follow the North Carolina Administrative Procedure Act (N.C.G.S. Chapter 150B).