Get Consent To Release Confidential Information - Illinois State ...

Filling out the Consent To Release Confidential Information form is an important step in allowing the Illinois State Disbursement Unit to share your information with specified individuals or organizations. This guide will provide you with clear instructions to complete the form online efficiently and accurately.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the Consent To Release Confidential Information form and open it for editing.
2. In the first section, enter your name as it appears in department records. This is essential for identification purposes.
3. Next, include your birth date in the format of month, day, and year. This further verifies your identity.
4. In the next field, provide the name of the individual or organization to which the information should be disclosed. Ensure this is accurate to avoid issues.
5. List the docket number(s) that the requested information pertains to. Include all relevant docket numbers to ensure completeness.
6. Indicate the issuing county related to the docket number(s) you listed. This helps in proper routing of information.
7. Specify the nature of the information to be disclosed and the purpose of the disclosure. Provide detailed descriptions to clarify the intent.
8. Set an expiration date for this consent. Remember, without an extension, it automatically expires 120 days from the date notarized.
9. Sign the document where indicated. This finalizes your authorization for the disclosure.
10. Include your social security number in the designated space to complete the identification process.
11. Fill in your mailing address, including the city, state, and zip code, to ensure the form goes to the correct location.
12. Provide a daytime phone number where you can be reached for any follow-up queries.
13. After completing all sections, you may save your changes, download, print, or share the form as needed.

Complete your documents online today for a smooth and efficient process.