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An authorized representative may be appointed at the time of application, renewal or any other times designated by the applicant or beneficiary. Likewise, a court order establishing legal guardianship, or a power of attorney should be recognized and documented as written consent by the applicant or beneficiary for lawful representation. Applicants and beneficiaries may authorize their representatives to: • Sign an application on the applicant's behalf • Complete and submit a renewal form • Receive copies of the applicant or beneficiary's notices and other communications from the agency • Act on behalf of the applicant or beneficiary in all other matters with the agency.

Authorized representatives must agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the applicant or beneficiary provided by the agency. The authorization will remain valid until the applicant or beneficiary modifies the agreement or notifies the agency that the representative is no longer authorized to act on his or her behalf. Similarly, the authorized representative may inform the agency that he or she no longer representing the client, or there is a change in the legal authority upon which the individual or organization's authority was based. Notification should include the applicant or authorized representative's signature as appropriate.

For authorized representative agreements which are not based on an existing legal authority, the official AUTHORIZED REPRESENTATIVE FOR HEALTH COVERAGE (State Form 55366) form must be signed by both the member and the authorized representative. Alternate forms or letters will not be accepted. Authorized representative agreements can be accepted via mail, fax, submission via the benefits portal, agreement on the telephone, or may be dropped off at a local DFR office. See below for more information on telephonic AR agreements and electronic signatures. Authorized Representative relationships agreed to over the telephone A verbal authorization is acceptable from the member for any Authorized Representative (AR). A three-way call will need to be completed between the member and AR to obtain and confirm the specific AR details. The information must be entered on the Authorized Representative or Legal Guardian Detail page during the call. After the AR information is entered into the eligibility system and the applicant and AR agree on the terms of authorization, it will remain in the system as an authentic and verified agreement unless/until the AR or applicant/recipient withdraws the authorization. AR details must be documented in case notes.