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Petition for Informal Adjudication
Petition requesting informal resolution of a dispute with a federal agency without a formal administrative hearing.
PDF TemplateUse the instructions below to complete this form
Instructions
Describe the dispute and the agency action at issue. Explain why informal resolution is appropriate and propose a resolution. Include all relevant facts and supporting documents. The agency may offer mediation, settlement conference, or alternative dispute resolution. Informal adjudication does not waive your right to a formal hearing if available.