A request for administrative review will be on a form provided by the administrator, be accompanied by an administrative fee, and contain the following information:
(A) The name, address and telephone number of the person making the request;
(B) A description of the decision, determination or order which is the subject of the review, and the date such decision, determination or order was made or issued;
(C) A brief description of all grounds for making the request; and
(D) Such other information as may be required by the administrator.
(Ord. 1099, passed 4-19-04)