Maine Authorization to Release Credit Information

State:
Multi-State
Control #:
US-03084BG
Format:
Word; 
Rich Text
Instant download

Description

This credit information release form authorizes the release of the applicant's credit history and information to specified companies & credit reporting agencies. This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

How to fill out Authorization To Release Credit Information?

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FAQ

Call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711(Maine relay).

Income & Asset Limits for Eligibility 2023 Maine Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleIncome LimitAsset LimitInstitutional / Nursing Home Medicaid$2,742 / month*$10,000?Medicaid Waivers / Home and Community Based Services$2,742 / month?$10,000?1 more row ?

Eligibility and Benefits Questions DISTRICT OFFICECONTACT (TTY: Maine Relay 711)Farmington District Office 114 Corn Shop Lane Farmington, Maine 04938 Show MapGeneral Information: (207) 778-8400 Toll Free: 1-800-442-6382 Fax: (207) 778-8410 or (207) 778-8429 farmington.dhhs@maine.gov15 more rows

If you have questions or concerns about your EBT or P-EBT account please call the number on the back of your card, (800) 477-7428, or the OFI Call Center even if you get a text or e-mail asking you to contact a different number.

To check your application status call MaineCare Member Services at 1-800-977-6740.

Contact Details Organization Type:State Medical Assistance OfficeOrganization Description:Medicaid programCovered States and Territories:MaineInformation:Toll Free: (800) 977-6740 Fax: (207) 287-9229 Web Site: Hours: am - pm1 more row

Contact the Privacy Official of the provider or facility where you received services to address your concern. File a complaint with the US Department of Health and Human Services Office of Civil Rights, which oversees HIPAA.

Contact Us Eligibility and Benefits Questions. Phone: 1 (855) 797-4357. For help logging into your My Maine Connection Account: MMCHelp.DHHS@maine.gov. Electronic Benefit Transfer Card. For EBT self-service, please visit

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Maine Authorization to Release Credit Information