Get Authorization For Disclosure Of Information Form ... - Benefeds.com

Filling out the authorization for disclosure of information form is an important step in managing your benefits under the Federal Employees Dental and Vision Insurance Program (FEDVIP). This guide will help you navigate the process with clear and concise instructions.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the personal information section, enter your first name, middle initial, and last name. Ensure that all names are spelled correctly as they appear on official documents.
3. Fill in your address including Address 1, Address 2 (if applicable), city, state/territory, country, and zip/foreign postal code. This information is crucial for accurate identification.
4. Provide your date of birth by selecting or entering the month, day, and year. This helps in verifying your identity.
5. Optionally, enter your BENEFEDS user ID if you have one. This can expedite the processing of your form.
6. In the authorization section, list the names of the individuals to whom you authorize the disclosure of information along with their relationships to you. Ensure that the names are spelled correctly.
7. Include the telephone numbers of the authorized individuals for any follow-up communication.
8. Sign and date the form. If a legal representative signs, ensure to print their name and describe the authority they have to act on your behalf, along with any supporting documentation.
9. After completing the form, you can save changes, download, print, or share the form as needed.

Take action now and complete your forms online to manage your benefits effectively.