Get Ebt - Request For Authorized Representative / Designated Alternate Cardholder - File Lacounty

This guide provides clear and supportive instructions on completing the EBT - Request for Authorized Representative / Designated Alternate Cardholder form. By following these steps, users can ensure that their designated representative has the necessary access to benefits.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date, case name, case number, worker name, worker ID, and worker phone number at the top of the form. This information helps identify your case.
3. Provide the name of the designated alternate cardholder/authorized representative. Ensure that the name is printed clearly.
4. The social security number and birthdate of the designated alternate cardholder/authorized representative are optional. If the designated representative chooses to provide this information, it is only necessary for specific customer service purposes.
5. Indicate the type of access you wish to grant the designated alternate cardholder by marking one of the following options: 'Cash Aid only', 'CalFresh only', or 'Cash Aid and CalFresh'.
6. The participant must provide their legal signature, phone number, and date. This confirms their understanding of the responsibilities associated with granting access.
7. The designated alternate cardholder/authorized representative must also sign the form, provide their phone number, and date. This acknowledgment is essential for their role.
8. Once all sections are completed, review the form for accuracy before submitting it. Users can save changes, download, print, or share the form as necessary.

Complete your forms online to ensure prompt processing of your authorized representative or designated alternate cardholder request.