Fillable REQUEST FOR STATE HEARING (California)

Fill Online, Printable, Fillable, Blank REQUEST FOR STATE HEARING (California) Form

Use Fill to complete blank online CALIFORNIA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

REQUEST FOR STATE HEARING (California)

On average this form takes 11 minutes to complete

The REQUEST FOR STATE HEARING (California) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 42 other fields

Country of origin: US
File type: PDF

BROWSE CALIFORNIA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
REQUEST FOR STATE HEARING
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.
TO ASK FOR A STATE HEARING:
Fill out this form.
Keep a copy of this form for your records.
Send this form to:
Department of Child Support Services
Office of Legal Services
State Hearings
P.O. Box 419087
Rancho Cordova, CA 95741-9087
OR
Call toll free: 1-866-289-4714
Fax: 916-464-5069
Email to: StateHearings@dcss.ca.gov
HEARING REQUEST INFORMATION:
COMPLAINANT NAME (Last) (First) (M.I.)
TELEPHONE NUMBER
MAILING ADDRESS
FAX NUMBER
CITY
COUNTY
STATE
ZIP CODE
E-MAIL ADDRESS
DATE OF BIRTH
SOCIAL SECURITY NUMBER
Note: The Department of Child Support Services 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.
Please answer the following questions:
1.
Have you gone through the complaint resolution process?
Yes No
If no, you must complete the complaint resolution process before you can
request a state hearing.
2.
Has it been more than 30 days since you requested complaint resolution?
Yes No
3.
Did you receive a resolution notice (Form LCR 006) from the local child support
agency?
Yes No
4.
What county is your complaint against?
5.
In what county do you want your hearing held?
I want a state hearing because:
(If you need more room, you may continue on another page and attach it to this form.)
SH 001 (06/09)
CONTINUED ON REVERSE
I need the State to provide me with an interpreter at no cost to me. (A relative or friend cannot interpret for you at the
hearing). My language or dialect is:
I have a disability and need the State to provide me the following reasonable accommodation to participate at my
hearing:
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
TELEPHONE NUMBER
STREET ADDRESS
CITY
Sacramento
STATE
ZIP CODE
COMPLAINANT'S SIGNATURE
DATE
REQUEST FOR STATE HEARING Page two
RIGHT TO A STATE HEARING:
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.
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 sup
p
ort 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
Department of Child Support Services, or you can call the Department of Child Support Services toll free at
1-866-289-4714.
The Department of Child Support Services will let you know the date, time, and place of your State Hearing.
The Department of Child Support Services 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.
State Hearings will only be granted for the following issues:
An application for child support has been denied or has not been acted upon within the required time.
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.
The local child support agency's decision to close a child support case.
IMPORTANT: The following issues cannot be heard at a State Hearing:
Child support issues that must be addressed by motion, order to show cause, or appeal in a court.
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.
Complaints of alleged discourteous treatment by a local child support agency employee, unless such conduct
resulted in a hearable action or inaction.
OMBUDSPERSON SERVICES:
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.
IMPORTANT: The Ombudsperson cannot represent you at the State Hearing or give you legal advice.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

REQUEST FOR STATE HEARING (California)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 September 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document