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.


Date Issued: June 21, 2010