Consent Form

Instructions

Please be advised that in order to take advantage of the Office of Administrative Hearings e-filing system, all appellants and agency heads will need to sign and submit a consent form prior to usage.

Form

E-filing Terms of Use agreement

Please read the instructions below for instructions on how to sign and submit the form.

DCF Forms

Please be advised there are time limits or deadlines in which your appeal must be filed. Review the notice you received from DCF so you are aware of the deadline or deadlines in your particular case or cases.

While no specific form is required, below are copies of forms you may use. Be sure to:

• Complete the form as best you can.
• Identify the specific action you are appealing and the DCF office that took the action you are appealing.
• Sign the form.
• Attach a copy of the notice from which you are appealing.
• Send to the Office of Administrative Hearings via Email, U.S. mail, or by FAX to (785) 296-4848.

Email-Specific Instructions

After downloading the form:

• Complete it, sign it, and save your changes.
• Create a new email and attach the completed/signed form along with a copy of the notice.
• Send it to oah@ks.gov.

Some PDFs support creating the email and attaching the file for you, using certain apps. The Submit button in the PDF may not work properly in other apps. The recommended apps are:

Windows and macOS (Desktop)	Adobe Reader or Foxit Reader
Google Android (Mobile)	Adobe Reader
Apple iOS (Mobile)	Adobe Reader

The recommended apps include the functionality to fill, sign, and create an email with your filled out form automatically.

Downloadable Forms

• Request for Administrative Hearing
• Notice of Withdrawal of Appeal

MEDICAID Forms

Please be advised there are time limits or deadlines in which your appeal must be filed. Review the notice you received from DCF so you are aware of the deadline or deadlines in your particular case or cases.

While no specific form is required, below are copies of forms you may use. Be sure to:

• Print the form.
• The "Provider request" form is only applicable for hearings sought by Medicaid service providers regarding the provider's Medicaid reimbursement. Prior to requesting any such fair hearing, Medicaid service providers must first satisfy all applicable contractual and regulatory review processes.
• Complete the form as best you can.
• Identify the specific action you are appealing and the state agency (DCF, KDADS, or KDHE) that took the action you are appealing.
• Sign the form.
• Attach a copy of the notice from which you are appealing.
• Send to the Office of Administrative Hearings via U.S. mail or FAX (785) 296-4848.

Go to Medicaid Forms