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This version of the form is not currently in use and is provided for reference only. Download this version of
Form OMHA-100
for the current year.
Form OMHA-100 Request for Administrative Law Judge (Alj) Hearing or Review of Dismissal
What Is Form OMHA-100?
This is a legal form that was released by the U.S. Department of Health and Human Services on March 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is OMHA-100?
A: OMHA-100 is a form used to request an Administrative Law Judge (ALJ) hearing or review of dismissal.
Q: What is an Administrative Law Judge (ALJ) hearing?
A: An ALJ hearing is a legal proceeding where an impartial judge reviews evidence and arguments related to a specific case or legal matter.
Q: When should I use the OMHA-100 form?
A: You should use the OMHA-100 form when you want to request an ALJ hearing or review of dismissal.
Q: What is the purpose of requesting an ALJ hearing or review of dismissal?
A: The purpose is to present your case and arguments to an impartial judge and seek a fair resolution or reconsideration of a previous dismissal.
Q: What information is required on the OMHA-100 form?
A: The form requires you to provide details about your case, such as your contact information, Medicare number, specific issues in dispute, and any supporting documentation.
Form Details:
- Released on March 1, 2017;
- The latest available edition released by the U.S. Department of Health and Human Services;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form OMHA-100 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services.
Download Form OMHA-100 Request for Administrative Law Judge (Alj) Hearing or Review of Dismissal
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