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How to fill out the Signed Authorization To Release Information Form - Delaware State online
Filling out the Signed Authorization To Release Information Form is an important step in applying for assistance through the Wilmington Senior Real Estate Tax Assistance Program. This guide will provide you with clear, step-by-step instructions to help you complete the form correctly online.
Follow the steps to successfully fill out the form
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In the first section, provide your full name as the applicant. If there are multiple applicants, include all names and respective roles.
- In the next field, enter your current address, including the property address you are applying assistance for.
- Proceed by signing the authorization statement, confirming your understanding of the verification process undertaken by the Delaware State Housing Authority (DSHA) and the associated agencies. Make sure to include the date of your signature.
- Input your social security number in the designated fields to ensure proper identification. If there is a second applicant, repeat this step for their information.
- Complete the agent contact name and designated DSHA approved agency information if applicable.
- Review all the entered information for accuracy. Once confirmed, you may save the changes, download, print, or share the completed form as needed.
Start completing your application form online to secure your assistance today!
The patient must provide the authorization of release of PHI to the covered entity. If the patient does not provide a written authorization of release of PHI, the doctor may not release the PHI – even if the patient gives “verbal permission.”
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