Updated Form 711- Request for Due Process - PRO-10-03
Attached is the revised VES- 711, Administrative Review /Mediation/Impartial Hearing Request form. Both the VESID VR Policy Internet webpage and CAMS will be updated to include the revised form.
Changes to the form include:
- New field for email addresses for both consumer and representative;
- VESID Policies and Procedures web address;
- Client Assistance Program main phone number and web address;
- Statement regarding time frame for initiating due process; within 90 days of the action or decision with which a consumer disagrees; and
- Information on where to return the completed VES-711 form.
EFFECTIVE DATE: Immediately
Date Issued: June 21, 2010