If you have received an order from an agency subject to OALP jurisdiction and would like to file a petition for review, you may do so by completing the form below.
By completing and submitting the online form, the agency that issued the order and the Office of Administrative Law Proceedings will deem you to have waived the requirement of service by U.S. mail or personal service outlined in IC 4-21.5-3-1(c) and your petition will be considered to be “filed” on the date this form is submitted.
- You will receive a reference number upon submission that will track your request prior to it receiving an administrative cause number.
- If you provide an email address for yourself, you will receive a copy of your submission.
- A copy of your submission will be provided to the state agency.
- Attorneys or non-attorney representatives may fill this form out on behalf of a person or entity.
- Filing a petition for review does not necessarily mean that you do not have to comply with the requirements of the initial agency action. Please review the initial agency action you received to determine the effective date of its requirements.
This form takes approximately 10-15 minutes to complete. You will need:
- Contact information for the aggrieved party or entity (aggrieved party is person or entity allegedly harmed by a state action);
- Attorney or representative contact information (if any – you may choose to represent yourself);
- A copy of the initial agency action (a document you received indicating a state action has been or will be taken against you);
- State reasons why you are requesting the review of the action and the outcome you wish to see.
A paper copy of this form is available for download: Word | PDF
Mail paper requests to:
Office of Administrative Law Proceedings
100 N. Senate Avenue Suite N802
Indianapolis, IN 46204
Attention: Do not use this form if you are contesting an action by the Family and Social Services Administration or its agent concerning Medicaid members, SNAP, TANF, Licensing for Child Care Homes and Centers, Tax Intercept, or Vocational Rehabilitation. Rather, please visit www.in.gov/oalp/resources-for-fssa-appeals for information on how to appeal decisions concerning those actions.
You may locate additional information about OALP processes here.
Petition for Review: Individuals or Entities
- Click here to complete the form.