REQUEST TO ADJOURN A FAIR HEARING
Office of Administrative Hearings
P.O. BOX 1930
Albany, NY 12201-1930
(877) 209-1134
 
Note: For security purposes, you have 15 minutes to complete this form, otherwise your request will not be received and you will need to start over.
 
WRITTEN REQUESTS FOR ADJOURNMENTS SUBMITTED LESS THAN SEVEN DAYS PRIOR TO THE HEARING MAY NOT ALLOW SUFFICIENT TIME FOR PROPER PROCESSING AND WRITTEN RESPONSE SHOULD IT BE NECESSARY.
 
  Indicates Required Information. Correct and complete information will permit us to promptly process your request.
 
 
 
 
      
 
 
Appellant Information
 
 
 
 
 
  please note any changes in address
 
 
 
 
 
 
 
Representative Information
(If there is a representative or you are NOT the person listed above)
 
 
 
 
 
 
 
 
 
Please enter an email address for Yourself or Representative:
  (if no email address is available enter the name of the person filling out this form)
 
 
RESTRICTIONS FOR FUTURE RESCHEDULING
Mark the days or times you or your representative cannot participate in a hearing and explain in the comment box below.
 
 
What is the reason you cannot attend at these times?

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What was the reason you cannot or did not appear at the hearing?

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We will notify you if your request for Adjournment/Rescheduling is denied.