Administrative hearings

Division of Licensing and Background Checks

This page provides instructions on how to request an administrative hearing with DLBC. Administrative hearings are a formal process used to resolve disputes concerning actions taken by DLBC. To dispute actions taken by another agency, you must contact that agency specifically.

Instructions

Download the request form

Administrative hearing request form

Complete the form

Requestor information

Enter the name of the facility or agency you work for, your name, email address, mailing address, phone number, city, state, and ZIP code.

Reason for request

Select one of the options from the menu. Multiple options may be selected by holding the CTRL key (command key on Mac) while clicking. If Other is selected, please provide an explanation in the space provided.

Explanation of request

Include specific details about the event and why it is being disputed. If the space provided is insufficient, additional pages may be attached to the form.

Signature

Sign and date the form.

Legal representative information

If you will represent yourself at your hearing, you may leave this section blank. If you wish to have another individual represent you, you may provide that information here.

Obtaining attorney representation will be at your own expense.

Submit your request

If you own or are employed by a program actively regulated by DLBC, you must submit your request through the DLBC provider portal.

Log into your portal, or have your administrator log in if you personally do not have access.
Select Request for Administrative Hearing from the PROVIDER MENU.
Select New Request.
Select at least one option under What action are you appealing?.
Select Choose File under the Administrative Hearing Form to upload your completed administrative hearing request form. Additional documentation may also be attached separately.
Select the office that took the action being disputed (either the Office of Licensing or Office of Background Processing).
Check the box to acknowledge that submitting the form does not guarantee an immediate resolution.
Enter your name, email address, and phone number.
Select Submit.

If you do not have access to the DLBC provider portal, you may email your completed administrative hearing request form to [email protected].

After receiving your request, DLBC will initiate the internal dispute resolution process. This process is used to determine if a dispute can be resolved without an administrative hearing.

This process does not preclude your right to a subsequent administrative hearing.

If it is determined that an administrative hearing is necessary, or you request that one take place regardless of DLBC's internal dispute resolution decision, the Office of Administrative Hearings will contact you to schedule your administrative hearing.