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If there is question as to whether a submission or statement is sufficient, send to PAL for review before taking an adverse action on the case. 2025.05.10 COLLATERAL CONTACTS

There are some institutions such as banks, insurance companies, and medical institutions which will not release information without the written consent of the individual. If information from such sources is essential to the determination of eligibility, and the individual does not or cannot provide the necessary information and refuses to sign a release form, eligibility cannot be established, and consequently the application must be denied.

When contacting collateral contacts, disclosure of information should be limited to that which is necessary to obtain the information being sought. Disclosure that the AG has applied for or is receiving Medicaid should not occur.

2025.10.00 RESPONSIBILITY FOR OBTAINING VERIFICATION

The applicant or authorized representative has the responsibility for providing adequate data to substantiate the request for assistance. The applicant or authorized representative is not required to present evidence in person at the DFR. The evidence may be supplied in person, through the mail, by facsimile or other electronic devices as listed in IHCPPM 2025.05.00. Some information may be obtained electronically through interfaces or other databases as specified in the State’s Verification Plan.

Assistance in Obtaining Verifications: If it is difficult or impossible for the individual or authorized representative to obtain the evidence in a timely manner or the AG has presented insufficient documentation, the worker must help. This assistance includes collateral contacts, faxing the signed Authorization for Release of Financial Information (State Form 3234/ FI 0014) or the Life Insurance Verification (State Form 4478/FI 0775) to the financial institution or sending the signed Request for Earnings Information (State Form 54092/DFR 0065) to the employer.

Good judgment is required on the part of workers when determining what, if any, verifications can be furnished by the applicant or authorized representative. The worker should accept any reasonable evidence and will be primarily concerned with how adequately the evidence proves the statements on the application. When neither the worker nor the applicant/recipient can secure the necessary documentation, the applicant/recipient's written statement may be acceptable information, except for certain eligibility factors (Refer to 2025.10.05).