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Administrative Appeal of Agency Decision

Appeal form challenging an adverse decision by a federal agency, seeking review by a higher authority within the same agency.

PDF TemplateUse the instructions below to complete this form

Instructions

Identify the original decision being appealed, including the date and decision-maker. State the specific grounds for appeal: error of fact, error of law, abuse of discretion, or new evidence. Attach a copy of the original decision. File within the deadline specified in the agency's regulations, typically 30 to 60 days. Request a hearing if one is available under the agency's rules.