Get Ma Dta Permission To Share Information Form 2021-2025

Filling out the MA DTA Permission To Share Information Form is an essential step for individuals seeking to share their information with designated organizations. This guide provides clear instructions for completing the form online, ensuring a seamless experience for users.

Follow the steps to complete the form online efficiently.

1. Click the ‘Get Form’ button to access the document and open it in your online form editor.
2. In Section 1, enter your name as the DTA client or applicant, followed by either your DTA Agency ID or the last four digits of your Social Security Number. Next, provide your date of birth.
3. Moving to Section 2, check one or both boxes to indicate whether you permit DTA to share information about your TAFDC, EAEDC, and/or SNAP case with the organizations mentioned in Section 3.
4. In Section 3, write the name of the SNAP Outreach Partner or SNAP Path to Work Provider. Additionally, include their phone number, address, and organization ID for thorough identification.
5. Section 4 explains your right to change your mind. Note the contact methods provided to revoke your permission to share information if you choose to do so in the future.
6. Finally, in Section 5, sign and date the form, confirming your understanding and consent to share your information as specified.
7. Once you have completed the form, you can save your changes, download a copy, print it for your records, or share it as needed.

Complete your MA DTA Permission To Share Information Form online today to streamline your service process.