Transcription of Request for Complaint Resolution
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Request for Complaint Resolution
Request FOR Complaint Resolution To Request Complaint Resolution , you can either mail or deliver this form to the local child support agency you are complaining about, or call the local child support FOR AGENCY USE ONLY LCSA DATE OF RECEIPT LCSA CASE NUMBER agency to file your Complaint YOU ARE COMPLAINING ABOUT COMPLAINANT' S NAME (Last) (First) ( ) TELEPHONE NUMBER COMPLAINANT'S MAILING ADDRESS E-MAIL ADDRESS FAX NUMBER CITY STATE ZIP CODE DESCRIBE YOUR Complaint :(If you need more space, you may continue on another page and attach it to this form.) DATECOMPLAINANT'S SIGNATURE --THIS SECTION TO BE COMPLETED BY LCSA REPRESENTATIVE--This Request was taken (check one): in person by telephone by letter LCSA REPRESENTATIVE' S NAME (Print) LCSA REPRESENTATIVE' S SIGNATURE DATE LCR 001 (12/09) Complaint Resolution - STATE HEARING INFORMATION RIGHT TO Complaint Resolution : If you have a Complaint against a local child support agency for any action or inaction regarding your child support case, you have the right to Request Complaint Resolution from the local child support agency.
Aug 19, 2021 · satisfied with the local child support agency's complaint resolution or response, you have the right to request a State Hearing before an Administrative Law Judge. IMPORTANT: Your request for State Hearing must be made within 90 days after you received the local child support agency's written response to your
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