This version of the form is not currently in use and is provided for reference only. Download this version of Form OMHA-100 for the current year.
This is a legal form that was released by the U.S. Department of Health and Human Services on March 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is OMHA-100?
A: OMHA-100 is a form used to request an Administrative Law Judge (ALJ) hearing or review of dismissal.
Q: What is an Administrative Law Judge (ALJ) hearing?
A: An ALJ hearing is a legal proceeding where an impartial judge reviews evidence and arguments related to a specific case or legal matter.
Q: When should I use the OMHA-100 form?
A: You should use the OMHA-100 form when you want to request an ALJ hearing or review of dismissal.
Q: What is the purpose of requesting an ALJ hearing or review of dismissal?
A: The purpose is to present your case and arguments to an impartial judge and seek a fair resolution or reconsideration of a previous dismissal.
Q: What information is required on the OMHA-100 form?
A: The form requires you to provide details about your case, such as your contact information, Medicare number, specific issues in dispute, and any supporting documentation.