Washington Administrative Code
Title 182 - Health Care Authority
PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM
Chapter 182-16 - Appeals practice and procedure
Part II - BRIEF ADJUDICATIVE PROCEEDINGS
Section 182-16-2070 - What should a written request for administrative review and a request for brief adjudicative proceeding contain?
Current through Register Vol. 24-18, September 15, 2024
A written request for administrative review of the employing agency decision and a request for brief adjudicative proceeding should contain:
(1) The name and mailing address of the party requesting an administrative review or the brief adjudicative proceeding;
(2) The name and mailing address of the appealing party's representative, if any;
(3) Documentation, or reference to documentation, of decisions previously rendered through the appeal process, if any;
(4) A statement identifying the specific portion of the decision being appealed and clarifying what is believed to be unlawful or in error;
(5) A statement of facts in support of the appealing party's position;
(6) Any information or documentation that the appealing party would like considered;
(7) The type of relief sought; and
(8) The signature of the appealing party or the appealing party's representative.
