Administrative Hearing Request

Use this form to request a hearing in response to an order of suspension issued for an insurance violation. You may only use this form if your suspension order states that you have a right to request a hearing.

IMPORTANT NOTE: Scheduling information and hearing correspondence will be sent to the mailing address listed on your DMV record. If your address has changed, please report your new address prior to requesting a hearing. You may update your record immediately by changing your address online if you live in Virginia and can establish a DMV PIN online. Otherwise, you may complete an Address Change Request (ISD01) form and either mail it in, or bring it to your local DMV customer service center prior to requesting a hearing.

Indicates required field

First Name

Middle Name

Last Name

VA Driver's License/Customer Number

Contact Phone Number

Address Line 1

Address Line 2

City

State

ZIP Code

Vehicle Make

Vehicle Year

Order of Suspension Issue Date

Co-Owner (if applicable)

Did any of the following special circumstances apply to the vehicle owner(s) at the time the order of suspension was issued? (Documentation will be required)

Active Duty Military

Incarceration

Hospitalization/In-patient treatment

Physical presence outside of the United states

None of the above

Reason

Please accept my request for a hearing. I am requesting this hearing because:

Document Guide

Registration Renewal

VirginiaMCS

Driving & Vehicle Records

Points Balance

Thanksgiving Holiday

Administrative Hearing Request