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Hawaii 240 request reconsideration 2026
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- Click ‘Get Form’ to open the Hawaii 240 Request for Reconsideration in the editor.
- Begin by entering the 'Date of Request' at the top of the form. This is essential for tracking your submission.
- Fill in your 'Provider Name', 'Contact Name', and 'Provider ID #' accurately to ensure proper identification.
- Provide your contact details, including 'Provider Phone #', 'Provider Fax #', and 'Provider Address'. This information is crucial for communication regarding your request.
- Enter the 'Claim Reference Number' and 'HAWI ID #' to link your reconsideration request to the specific claim.
- List the 'Date(s) of Service' related to your claim, ensuring all relevant dates are included.
- Attach any necessary documents by listing them in the 'List of Attached Documents' section. This supports your justification.
- In the 'Reconsideration Justification' field, provide a clear explanation of why you believe a reconsideration is warranted.
- Complete the section for 'Date FA Completed Research' and sign off with your name in the designated area before submitting.
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See more hawaii form reconsideration versions
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2014 | 4.8 Satisfied (106 Votes) |
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May 7, 2026 Testimony may also be submitted via email at bor.testimony@hawaii.edu, facsimile at (808) 956-5156.
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