Get Ucrs 158 For - Ucsb Human Resources - Hr Ucsb

Filling out the UCRS 158 form is an important step in authorizing the disclosure of your health care and vocational information. This guide provides clear, step-by-step instructions to ensure you can complete the form correctly and efficiently, even if you have limited experience with legal documents.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the UCRS 158 form and open it in the document editor.
2. In section A, provide the names of all relevant health care providers or institutions you authorize to release information. Make sure to provide a separate authorization for each provider.
3. In section B, fill out your personal details, including your name and Social Security number, ensuring accuracy for verification purposes.
4. Indicate the specific health records you authorize to be released, such as mental health records or substance abuse records, by initialing the relevant sections if you choose to restrict any information.
5. In section C, clearly state the purpose for which this information will be used, which is to evaluate eligibility for Disability Income benefits.
6. Familiarize yourself with section D, which mentions restrictions on further disclosure of your information.
7. In section E, acknowledge the duration of the authorization, which is valid for two years unless revoked in writing.
8. Proceed to sign and date the form in section H, ensuring that if you are a legal representative, you specify your relationship to the individual.
9. Review all filled sections to confirm that all necessary information is completed accurately.
10. Finally, save the changes you have made, and you have the option to download, print, or share the completed form as required.

Complete the UCRS 158 form online today to ensure your information is processed efficiently.