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One-time call permissions One-time only verbal authorizations are for that specific moment in time. AR should not be added to eligibility system and should only have access to information authorized by member. When a member is on the telephone, he or she may provide verbal authorization for anyone to act as the authorized representative for that individual call only. Subsequent phone calls will again require member’s verbal permission for information to be shared. Electronic signatures Electronic signatures for authorized representative agreements will only be accepted if it is completed with DocuSign, Adobe Acrobat, ESIGN, SignNow, UETA or other such official software which provides supporting verification that it was electronically signed by the applicant/member, such as a digital certificate issued by a certificate authority. If the name is added in a script font in word-processing software such as Microsoft Word, this is not allowable. Electronic signatures submitted via email, faxed directly to the DFR office (rather than to the Document Center at 1- 888-436-9199) or sent by other non-secured formats will not be accepted; however, if sent through the portal, mailed or faxed to the Document Center, or dropped off at the DFR local office, this is allowable. Any questions about the validity of the electronic signature should be submitted to PAL for review. The authorized representative must be familiar with the AG situation to represent them properly. The worker will determine if the authorized representative is representing the AG appropriately. If the applicant/recipient is failing to cooperate with the Authorized Representative, and the Authorized Representative is unable to obtain the required verifications needed to complete an eligibility determination, then contact should be made with the applicant/recipient to obtain verifications.

Authorized representatives assume responsibility for the accuracy of the information provided. AGs who utilize an authorized representative are subject to the same disqualification penalties and possible prosecution as AGs representing themselves. Note: If a member passes away, the authorized representative form remains valid, under the condition the POA or the AR being designated on the form signed while the member was living. 2015.00.00 RESPONSIBILITIES OF THE APPLICANT/RECIPIENT

The DFR must advise each applicant/recipient of his rights and responsibilities as indicated in the following sections.