Get Help Submitting an Appeal Hard Copy

Table of Contents

• Get Help Submitting an Appeal Hard Copy
• Step 1: Complete the Appeals Request Form
• Helpful Tips:

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Get Help Submitting an Appeal Hard Copy

All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, check the Levels of Appeals and Time Limits for Filing page.

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Step 1: Complete the Appeals Request Form

Download and complete the Complete the Part A Redetermination Request Form Level 1:

1. Complete the form by typing the appropriate information into the form. If you cannot type the request, please make sure your handwriting is legible.
2. Complete all areas of the form. An incomplete form will not be accepted and your request will be dismissed.

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Helpful Tips:

• Please make sure all items are completed. If there is not enough room on the form, please include an attachment that details the required information (i.e., include your remittance and placing a star next to all claims to be reviewed).
• If there is insufficient information with your appeal request, it may be dismissed.
• If you are submitting your appeal past the time limit, please include an explanation for the delayed request.

Please share your thoughts about your experience with our redetermination process.