Get Dshs 14 532 Form

The Dshs 14 532 Form is a crucial document for designating an authorized representative who will act on your behalf when applying for or receiving benefits from the Department of Social and Health Services (DSHS) or Health Care Authority (HCA). This guide will provide you with step-by-step instructions on how to complete the form online effectively.

Follow the steps to fill out the Dshs 14 532 Form online

1. Click the ‘Get Form’ button to access the Dshs 14 532 Form and open it for editing.
2. Fill in your personal information in the 'Client Information' section. This includes your full name and your ACES client ID number.
3. In the 'Authorized Representative Information' section, provide the representative's name. If applicable, include the organization and department they belong to, along with their phone number, mailing address, city, state, and ZIP code.
4. Specify which program(s) you would like your authorized representative to assist you with by checking all applicable boxes. Programs include cash benefits, basic food benefits, health care coverage, and long-term care coverage.
5. Indicate how long you want your authorized representative to act on your behalf by selecting either 90 days or until the end of the certification period.
6. In the 'Correspondence Information' section, choose the level of information your authorized representative should receive by checking one of the provided boxes.
7. Complete the 'Client Authorization' section by signing and dating the form. Ensure to print your name and provide your phone number.
8. Once you have filled out all sections, save your changes. You may then download, print, or share the completed Dshs 14 532 Form as needed.

Complete your Dshs 14 532 Form online today for efficient processing of your benefits.