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Website form for Consumer Appeals

Below is a form for you to submit an appeal to us concerning our response to your request that we take action concerning the personal information we may have collected about you or the person you are authorized to act on behalf of.

Please fill out the form below:

Your First Name

Your Last Name

Your Middle Initial

Street Address

City

State

Phone (optional)

Please explain why you believe that CHHJ incorrectly denied or rejected your privacy related request:

Are you submitting this request on behalf of another person?

Yes

Their First Name

Their Last Name

Based upon the nature of your appeal, we may ask you to provide additional information to verify your identity and, if making this appeal on behalf of another person, your authority to submit this appeal. The information that we request will depend on your prior interactions with us, and the nature and sensitivity of the information at issue.

We may also request that you provide more detail or explanation concerning your appeal, which may include, among other things, documentation or materials that support your appeal.

We will respond to your appeal within 60 days of receipt.