Hearing Request Form - 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)
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- hearing request form new york state comptroller
- disciplinary hearing checklist and form namhr
- informal hearing review request form
- request for hearing by administrative law judge
- request for administrative hearing
- request for a hearing form
- form 12153 request for a collection due process or
- sample hearing request form new york department of state
- requesting a hearing non jury trial in a family court case
- request for hearing
Related searches
- new york state education department
- new york state salary laws
- new york state education jobs
- new york state jobs current openings
- dhs hearing request form michigan
- new york state department of state licensing
- new york state traveler health form online
- new york state comptroller unclaimed funds
- new york state dept of state licensing
- new york state healthy new york
- new york state department of state ny
- new york state department of state corporate