Get Omha 119

The Omha 119 form is used to withdraw a request for an Administrative Law Judge hearing or a review of a dismissal. This guide provides a clear, step-by-step process to assist you in completing the form online with ease.

Follow the steps to successfully complete the Omha 119 form.

1. Click ‘Get Form’ button to access the Omha 119 form online and open it for editing.
2. In Section 1, provide the OMHA appeal number or the reconsideration appeal number. If you do not have the OMHA appeal number, enter the reconsideration number.
3. Move to Section 2 and fill in the information for the party withdrawing the request. Enter the following details: Telephone number, First name, Middle initial (if applicable), Last name, and the name of the Firm or Organization (if relevant).
4. If applicable, proceed to Section 3 and provide the representative's information. Include their Name, Telephone Number, and the Firm or Organization (if relevant). If you do not have a representative, you can skip this section.
5. In Section 4, acknowledge the statements by signing and dating the form. Ensure you understand the implications of submitting the withdrawal request, particularly regarding the potential dismissal of your appeal.
6. Once all sections are completed, review the form for accuracy. You can then save changes, download, print, or share the completed form as needed.

Take action today and complete your Omha 119 form online for a seamless withdrawal process.