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AdministrativepdfFederal
Administrative Hearing Request
Request for a formal or informal hearing before an administrative law judge to contest an agency action or enforcement decision.
PDF TemplateUse the instructions below to complete this form
Instructions
State the agency action you are contesting and the statutory or regulatory basis for your right to a hearing. Identify the issues of fact and law in dispute. Request specific accommodations if needed (interpreter, telephone participation). File within the deadline specified in the agency's notice, typically 15 to 30 days. You may represent yourself or retain legal counsel.