Outdated or Unsupported Browser Detected
DWD's website uses the latest technology. This makes our site faster and easier to use across all devices. Unfortunatley, your browser is out of date and is not supported. An update is not required, but it is strongly recommended to improve your browsing experience. To update Internet Explorer to Microsoft Edge visit their website.
Document Number: DVR-10527-E
Description: This form may be completed by consumers who are requesting a hearing as part of the formal appeal process.
Comments: This form is protected from modification and enabled for form fill (includes tabbed fields for form completion).
Content Contact: DVR Forms
Document Attachment: DVR-10527-E (Electronic Version - Word/46 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.