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HO SB Sponsor paying premiums. Sponsors name and address sent to Office of Financial Recovery. NA Client Authorization AUTHORIZED BY CLIENT SIGNATURE DATE SIGNED PRINT NAME NOTE HIPAA restrictions prevent us from discussing the client s individual health information with the authorized representative unless the representative has power of attorney for the client or the client has signed a DSHS 14-012 Consent form. This includes disclosure of ment.

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... by completing the agency's Authorized Representative Designation Form (DSHS 14-532)...
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ID ITD 3367 2016 IL VSD 62 2017 IN SF 44237 2012 KY TC 96-187 2012

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The most common example of an authorized representative is a person acting on behalf of a company. What is this? For instance, if a company CEO or President signs a document on behalf of the company, that person is the authorized representative of the company.

Click on Office Locator for more information on the Community Services Office nearest you. Our highest call volume times are between the hours of 11 a.m. and 3 p.m., Mondays and on the first and last three work days of the month. If you call during these times, you may experience delays in speaking with an agent.

All telephone menus are available in English, Spanish, Russian and Vietnamese. We also provide interpreter services for most languages. All documents may be faxed, toll-free, to 888-338-7410 or mailed to PO Box 11699, Tacoma, WA 98411-9905.

The DSHS 14-532 authorized representative form shall be used when a client is authorizing an AREP at a time other than at application or eligibility review. The AREP information shall be reviewed at recertification. See WORKER RESPONSIBILITIES.

Client Resources - Assistance & Contact Information 1-877-734-6277. TTY: 1-833-866-5595. Email: apscentralintake@dshs.wa.gov. Make a report online. Get more information on adult abuse and neglect. If the person is in immediate danger, call 911.

An authorized representative can be a family member, a caregiver, or other person that you trust to make important decisions related to your health care. Some authorized representatives may have legal authority to act on your behalf.

Someone who you choose to act on your behalf with the Marketplace, like a family member or other trusted person. Some authorized representatives may have legal authority to act on your behalf.

An authorized representative's primary role is to represent an individual or company in different official transactions. They have the authority to communicate, liaise, negotiate, and make decisions ing to goals and project requirements.

Stop Work Questionnaire (form 14-438) This form is used when you stop work or self employment. The form should be signed by you but must be completed by your employer. Your employer can also complete this form On-Line.

If the represented person is bound, the signature of the representative is the “authorized signature of the represented person” and the represented person is liable on the instrument, whether or not identified in the instrument.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232