Send to: The Office of Administrative Hearings 2349 Gateway Oaks Dr. Suite 200 Sacramento CA 95833 (916) 263-0550 FAX (916) 376-6318 320 West Fourth Street Suite 630 Los Angeles CA 90013 (213) 576-7200 FAX (916) 376-6395 1350 Front Street Suite 3005 San Diego CA 92101 (619) 525-4475 FAX (916) 376-6325 1515 Clay Street Suite 206 Oakland CA 94612 (510) 622-2722 FAX (916) 376-6323 Regarding: _________________________________ ____________________________________ Claimant's Printed Name Regional Center ________________________________________ ___________________________________________ Date OAH File Number Waiver of Time Set by Law for Lanterman Act Fair Hearing and Decision I waive my right to have a fair hearing within 50 days of the date the service agency received my fair hearing request (Welf. & Inst. Code, § 4712(a)). I also waive my right to have a final administrative decision rendered within 80 days of the of the date the service agency received my fair hearing request (Welf. & Inst. Code, § 4712.5, subd. (a)) or within 90 days if applicable to my case (see Welf. & Inst. Code, § 4712.5, subd. (c)). I do not waive my right to have the hearing officer render a decision within ten working days of the submission of the case for decision (Welf. & Inst. Code, § 4712.5, subd. (a)). _________________________________ ____________________________________ Signature: Claimant or Claimant's Representative (OAH Form 62; Rev 08/10) Printed Name: Claimant or Claimant's Representative American LegalNet, Inc. www.FormsWorkFlow.com