Get Ca Ds 1805 2007-2025

The CA DS 1805 form is a crucial document for individuals seeking a fair hearing regarding decisions made by regional centers or state developmental centers. This guide will provide a step-by-step approach to completing the form online, ensuring that you can submit your request accurately and effectively.

Follow the steps to complete the CA DS 1805 form online.

1. Click ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by filling in the name of the person for whom the hearing is requested (claimant) and their date of birth.
3. Provide the address of the claimant and their daytime telephone number.
4. Indicate whether the claimant is a Medicaid Home and Community Based Services Waiver participant by checking the appropriate box.
5. Enter the name of the regional center or state developmental center associated with the claim.
6. Select any additional requests, such as an informal meeting or mediation, by checking the relevant boxes.
7. Clearly describe the reasons for requesting a fair hearing and what is needed to resolve the complaint in the designated fields.
8. If the requester is not the claimant, fill in their name, relationship to the claimant, address, and daytime telephone number.
9. Securely sign the form with the requester’s signature and date of request.
10. Determine if interpreter services are required; if yes, indicate the language needed.
11. If applicable, provide details about any representative authorized to act on behalf of the claimant, including their name, address, and daytime telephone number.
12. Specify any dates or times when the claimant or authorized representative is unavailable.
13. Finish by reviewing all entries for accuracy and completeness before saving, downloading, or printing the form.

Take action and complete your CA DS 1805 form online for a fair hearing request.