Request to Reschedule

Please fill out the form below to submit a request to reschedule a hearing. Please be aware that whether to grant the request to reschedule the hearing is the hearing officer’s decision and within his or her discretion.

that I am the above-mentioned beneficiary or provider or an authorized representative for the beneficiary or provider requesting to reschedule my fair hearing. I understand that it is the hearing officer’s decision whether the hearing will be rescheduled.
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