Job & Family Services Office of Legal and Acquisition Services
Bureau of State Hearings
Administrative Appeal Request

If you believe your state hearing decision is wrong, you may request an administrative appeal by completing this form and signing it. Use of this form is optional and you may also make a request in writing within 15 days to the Bureau of State Hearings by fax, email, mail or by dropping the request off with your caseworker. To request an administrative appeal, please complete the required information below.

* Indicates Required Field

Case Number:
First Name:
Last Name:
Zip Code:
Phone Number with Area Code:
Email Address:
Hearing Decision Mail Date:
 [None] Select a Date Delete the Date
List the appeal(s) number(s) for administrative appeal:

I disagree with the state hearing decision because: (select at least one)

Explain why you disagree with the decision: (1000 character limit)

By typing your electronic signature below, you are saying you are the person requesting the Bureau of State Hearings to process an administrative appeal request for you. Individuals who you have given the right to represent you and sign on your behalf must be designated as an authorized representative on the decision in order to process this request. Otherwise, the authorized representative will need to submit the administrative appeal request by following one of the methods below.

Electronic Signature (type your full name):

Here are the other ways to send an administrative appeal request and any attachments to ODJFS:

  • Emailbsh@jfs.ohio.gov .  Put "Administrative Appeal Request" in the subject line. 
  • Fax –  (614) 728-9574
  • Mail – ODJFS Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825.
  • Contact your caseworker – It is much better to send the request by one of the ways listed above.

 You can ask your local Legal Aid program for free help with your case. Contact your local Legal Aid office by phoning 1-866-LAW-OHIO (1-866-529-6446) or by searching the Legal Aid directory at http://www.ohiolegalhelp.org/find-legal-help/.