Use this Form to Ask DDS for Help with Your Hearing Decision

Effective July 1, 2022, the law requires regional centers (RCs) to implement  hearing decisions within 30 days.  If the RC can’t, they must send you a letter explaining why and when the hearing decision will be implemented.  

If you need help getting your decision implemented, please complete the form below. This form goes directly to DDS, so staff can follow-up with you. It does not go to your regional center.

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* 1. Contact Information for the Person Who Needs Services (Claimant):

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* 2. If you have, or are an Authorized Representative for the person above, please complete this section.

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* 4. Final Hearing Decision Case Number:

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* 5. Date of Final Hearing Decision

Date

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* 6. Decision requires the following (use 2-3 sentences to briefly describe what needs to be implemented):

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* 7. Please share why you are unsatisfied:

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* 9. Please upload any documents related to this hearing you think DDS should see:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 10. Do you have an additional document you need to attach?

T