Sample Letter #4 - How to Request an Impartial Hearing

(Insert date)
Bradley Hutton, MPH
Director, Bureau of Early Intervention
NYS Department of Health
Corning Tower Building, Room 287
Empire State Plaza
Albany, New York 12237

Dear Mr. Hutton:

I would like to request an impartial hearing for my child, (child's name), regarding early intervention services. I am having a problem with (state the problem).

The best time to reach me to arrange for a reasonably convenient time, place, and date for the hearing is on (insert days and times).


(Insert Name)
(Street Address)
(City/State/Zip Code)
(Area Code/Phone #)

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