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(4) an individual who has legal authority to act on the applicant’s behalf;

(5) the authorized representative appointed under 7 AAC 100.006(a); or

(6) an individual acting responsibly in the place of the applicant under 7 AAC 100.006(b). (Eff. 7/20/2007, Register 183) Statutory Authority: Authority: AS 47.05.010 AS 47.07.040 Editor’s note: Each type of Medicaid applicant form provided by the department, as referred to in 7 AAC 100.004, is available at any Division of Public Assistance office of the Department of Health and Social Services. 7 AAC 100.006. Authorized representative and individual acting responsibly. (a) An applicant 18 years of age or older may appoint a representative who, in the applicant’s place, is authorized to apply for Medicaid on the applicant’s behalf. An individual who is 18 years of age or older may be an authorized representative. The appointment of an authorized representative must be

(1) in writing; and

(2) signed and dated by the applicant and the authorized representative; if, due to the level of literacy or competence, the applicant’s signature is only a mark, the mark must be witnessed by two individuals who each date and sign their own name. (b) If an applicant is physically or mentally incapable of making application, and is incapable of appointing an authorized representative in accordance with (a) of this section, an application for assistance may be filed by an individual who is acting responsibly in the place of the applicant. (Eff. 7/20/2007, Register 183) Statutory Authority: Authority: AS 47.05.010 AS 47.07.040