Sample Hearing Request Letter - New York State Comptroller
Hearing Request
NYSLRS Attn: Hearing Administration 110 State Street Albany, NY 12244-0001 Fax: (518) 402-4137 Email: Hearings@osc.
Re: _____________________________________
(NAME OF NYSLRS MEMBER)
NYSLRS ID Number: ______________________
(NYSLRS ID)
Social Security Number: ____________________
(LAST 4 DIGITS ONLY IF NYSLRS ID IS UNKNOWN)
Dear New York State and Local Retirement System,
I am requesting a hearing because I disagree with the final agency determination mailed on ________________________________ .
(DATE OF DETERMINATION OR LETTER)
Sincerely, ________________________________________
(YOUR SIGNATURE)
________________________________________
(DATE)
________________________________________
(YOUR MAILING ADDRESS)
________________________________________
(YOUR EMAIL ADDRESS)
________________________________________
(YOUR TELEPHONE NUMBER INCLUDING AREA CODE)
................
................
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