ACKNOWLEDGEMENT LETTER FOR RECEIPT OF GRIEVANCE
{Date}
{Participant Name or Name of Representative}
{c/o Participant Name}
{Address}
Re: Acknowledgement of Receipt of Grievance
Dear Mr/s. {Name}:
This letter is to inform you that {PACE Program} received your grievance on {Date}regarding {insert brief statement of Participant’s grievance}. Please find enclosed a description of the {PACE program}Grievance Process, including notification of your right to request a State hearing at any time during the grievance process.
We take your grievance very seriously and are continuing to work toward resolving the issue to your satisfaction.
Within thirty (30) calendar days of receiving your grievance, {PACE Program Staff} will provide you with a written response about the findings of the investigation and the action taken to resolve the grievance. If you feel that waiting thirty (30) calendar days represents a serious health threat, we will expedite the review process to a decision within 72 hours of receiving your grievance. You may contact {Designated Individual} at {insert regular and toll-free (as applicable) telephone number(s)} at any time for information about your grievance. For the hearing impaired (TTY), please call {number}.
Thank you for working with us to resolve this matter.
Sincerely,
{Designated Individual}
/Enclosures