Regional Center (Service Agency) Mediation Request Response Form
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Regional Center (Service Agency) Mediation Request Response Form. This is a California form and can be use in Office Of Administrative Hearings Statewide.
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Tags: Regional Center (Service Agency) Mediation Request Response Form, California Statewide, Office Of Administrative Hearings
OFFICE OF ADMINISTRATIVE HEARINGS State of California Department of General Services SERVICE AGENCY MEDIATION RESPONSE FORM OAH-26 (10/07) TDD /TYY 800-735-2929 DATE: TO: DDS Calendar Clerk Office of Administrative Hearings 2349 Gateway Oaks Drive, Suite 200 Sacramento, CA 95833 Fax: (916) 263-0554 Phone: (916) 263-0550 FROM: MEDIATION REQUEST BY: Client(s) Name: ___________________________________ OAH Case No.: ___________________________________ This service agency: Accepts Does Not Accept the voluntary mediation requested by this client. Please note the following: Service Agency's availability for mediation: __________________________________________________ Additional Information: __________________________________________________ __________________________________________________ __________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com
