We are working to make the Appeal process easier and friendlier for you. Complete this electronic form with all the information required and click the Submit button once you are finished. Or you can download a PDF copy of this form and submit it via email or regular mail.
Please do not submit any confidential, proprietary or sensitive personally identifiable information (e.g., social security number; date of birth; driver’s license number; medical records; or credit card, bank account or other financial information). Please redact this information from exhibits where necessary.