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How to fill out the OHA 0232. Authorized Representative Form online
The OHA 0232. Authorized Representative Form is a crucial document for individuals wishing to designate someone to act on their behalf in discussions with the Oregon Health Authority. This guide provides straightforward instructions on how to complete the form online.
Follow the steps to fill out the OHA 0232 form online.
- Click ‘Get Form’ button to access the OHA 0232 form and open it in the online editor.
- In the first section, choose to designate either an individual or an organization as your authorized representative. If selecting an individual, provide their full legal name, including first, middle, last, and suffix. Include their birthdate in the format MM/DD/YYYY.
- If you are choosing an organization, fill in the organization name, the contact person's full legal name, and their birthdate using the same MM/DD/YYYY format.
- Next, provide your mailing address. Input the apartment or unit number if applicable, followed by the city, state, and ZIP code.
- Indicate your county and provide your phone number and email address for future correspondence.
- Select your relationship to the authorized representative from the options given, which may include Power of Attorney, Statutory benefit payee, or other relevant categories.
- Print your name, then provide your birthdate in MM/DD/YYYY format. This step confirms your identity as the applicant.
- Sign the application where indicated to authenticate your request, followed by including today's date.
- The authorized representative must also complete their section. They will need to print their name and sign the form, confirming their understanding of their responsibilities.
- Once all sections are completed, save your changes. You can then download, print, or share the form as needed.
Complete your OHA 0232 form online today to ensure your authorized representative is designated correctly.
To obtain the PR03 form, you can visit the US Legal Forms website. The platform provides a streamlined process to download the OHA 0232. Authorized Representative Form. Simply search for the form, select it, and follow the instructions to easily access your document.
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