Full Text
CONTINUED ON REVERSE YOUR HEARING RIGHTS: You have the right to request a state hearing if you are not satisfied with the local child support agency's resolution of your complaint, or if the local child support agency has not responded to you or resolved your complaint within 30 days of when you made your complaint. You have only 90 days to request a state hearing. The 90 days starts after you receive the local child support agency's written resolution to your complaint. If the local child support agency has not responded to your complaint in writing, the 90 days starts the day you made your complaint. Fill out this form. Keep a copy of this form for your records. Send this form to: State Hearing Office 744 P Street, M.S. 19-98 Sacramento, CA 95814 REQUEST FOR STATE HEARING TO ASK FOR A STATE HEARING: I want a state hearing because: (If you need more room, you may continue on another page and attach it to this form.) DATE OF BIRTH SOCIAL SECURITY NUMBER CITY E-MAIL ADDRESS FAX NUMBER COMPLAINANT NAME (Last) (First) TELEPHONE NUMBER MAILING ADDRESS COUNTY HEARING REQUEST INFORMATION: STATE ZIP CODE Call toll free: 1-[PHONE REDACTED] Did you receive a resolution notice (Form LCR 006) from the local child support agency? No In what county do you w ant your hearing held? OR Yes If no, you must complete the complaint resolution process before you can request a state hearing. SH 001 (10/01) No Yes No Yes Please answer the following questions: 5. What county is your complaint against? 1. 2. 3. 4. Has it been more than 30 days since you requested complaint resolution? Note: The State Hearing Office will not schedule a State Hearing unless you have first gone through the local child support agency complaint resolution process and it has been at least 30 days since you filed your complaint. Have you gone through the complaint resolution process? ---PAGE BREAK--- I want the person named below to represent me at this hearing. I give my permission for this person to have access to my records or attend the hearing for me. (This person can be a friend or relative but cannot interpret for you.) NAME STATE ZIP CODE I have a disability and need the State to provide me the follow ing reasonable accommodation to participate at my hearing: TELEPHONE NUMBER STREET ADDRESS I need the State to provide me w ith an interpreter at no cost to me. (A relative or friend cannot interpret for you at the hearing.) My language or dialect is: CITY COMPLAINANT'S SIGNATURE DATE REQUEST FOR STATE HEARING - Page two RIGHT TO A STATE HEARING: If the local child support agency does respond to you within 30 days of making your complaint, and you are not satisfied with the local child support agency's complaint resolution or response, you have the right to request a state hearing before an Administrative Law Judge. IMPORTANT: Your request for State Hearing must be made within 90 days after you received the local child support agency's written response to your complaint. You can request a State Hearing in writing by sending a Request for State Hearing form (SH001) to the State Hearing Office, or you can call the State Hearing Office toll free at 1-[PHONE REDACTED]. If the local child support agency does not respond to you within 30 days from receiving your complaint, you have the right to request a State Hearing before an Administrative Law Judge. IMPORTANT: Your request for a State Hearing must be made within 90 days after you complained to the local child support agency. The State Hearing Office will let you know the date, time, and place of your State Hearing. The State Hearing Office will provide an interpreter or disability accommodation for you at the hearing if you need one. IMPORTANT: Not all complaints can be heard at a State Hearing. The local child support agency's decision to close a child support case. State Hearings will only be granted for the following issues: The child support services case has been acted upon in violation of federal or state law or regulation, or California Department of Child Support Services policy letter, including services for the establishment, modification, and enforcement of child support orders and child support accountings. Child support collections have not been distributed, or have been distributed or disbursed incorrectly, or the amount of child support arrears, as calculated by the local child support agency is inaccurate. An application for child support has been denied or has not been acted upon within the required time Complaints of alleged discourteous treatment by a local child support agency employee, unless such conduct resulted in a hearable action or inaction. IMPORTANT: The following issues cannot be heard at a State Hearing: A review of any court order for child support or child support arrears. A court order or equivalent determination of paternity. A court order for spousal support. Child custody determinations. Child visitation determinations. Child support issues that must be addressed by motion, order to show cause, or appeal in a court. OMBUDSPERSON SERVICES: IMPORTANT: The Ombudsperson cannot represent you at the State Hearing or give you legal advice. Every local child support agency has an Ombudsperson available to help you through the complaint resolution and/or State Hearing process. The Ombudsperson can help you obtain information regarding your complaint to help you prepare for your State Hearing.