Form for RCs to Complete to Notify DDS

Effective July 1, 2022, W&I Code Section 4713.5 requires regional centers to implement a final hearing decision as soon as practicable, not later than 30 calendar days from the date of the final hearing decision. If a regional center is unable to implement a final hearing decision within 30 days, the claimant and their authorized representative must be notified in writing.

The exceptional circumstances that make it impossible for the regional center to implement the final decision, and the projected date that the decision will be implemented, must both be included in the notification.

Instructions
Complete the notification form below. This form goes directly to DDS. 
Attach a copy of the letter sent to the claimant and authorized representative notifying them of the delay.

Email HearingImplementation@dds.ca.gov if you have any questions.

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* 1. Regional Center

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* 2. Regional Center Contact Person Completing This Form

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* 3. Today's Date

Date

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* 4. Final Hearing Decision Case Number:

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* 5. Date of Final Hearing Decision

Date

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* 6. Decision Requires the Following (please use 2-3 sentences to summarize what's required by the final decision):

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* 7. Exceptional Reason for Non-Implementation Within 30 days (Please fill in reason(s) below):

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* 8. Actions already taken to attempt to implement the decision (please list action(s) below):

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* 9. Projected Date of Implementation

Date

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* 10. Please upload any supporting documentation:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 11. Do you need to submit additional documentation?

T