Generate an Appeal Summary Form - Non-Medical

To generate an Appeal Summary Form, follow these steps:

1. Select Document Control from Global Navigation. The Template Repository Search page displays.

2. Enter Fair Hearing Summary in the Form Name field, and click the Search button. Or the user may enter B-5 in the Form Number and click the Search button.

3. Select Fair Hearing Summary from the search results using the name hyperlink. The Document Parameters page displays.

4. Click the Select button for the Resource/Provider to navigate to the Resource Data Bank.

5. Select Office of Administrative Hearings from the Resource Data Bank.

6. Enter the Case Number and click the Go button.

7. Enter the Hearing ID and select the Program using the drop-down menu. Then click the Generate Form button. The Appeal Summary displays.

8. Choose the Print Locally option to print the Appeal Summary form.

9. Make two copies of the evidence attachments and a second copy of the Appeal Summary Form.

10. Mail one packet of the Appeal Summary and evidence attachments to OAH. The user sends the second packet to the appellant.