1411.5 Signature Requirement

As noted in 1411 , an application or review form must be signed to be considered a valid request for assistance. The signature must be both valid (see 1411.2 (6) ) and acceptable. An acceptable signature is one which meets the following requirements.

Paper Applications and Review Forms - Any mark or sign made by the person signing the application with the intent to represent the identity of that person is acceptable. This includes handwritten (wet), typed (mechanical), stamped, and scanned signatures. A handwritten signature does not have to be legible to be acceptable. If the person is marking the application with an “X” (or other symbol) because they are unable to sign their name due to illiteracy or disability, the signature of two (2) witnesses to validate the identity of the person making the mark is required. A signature provided in the wrong place in most instances shall not disqualify the application as long as the signature is both valid and acceptable. This applies to signatures provided on either the signature page or the medical representative authorization page of the application. NOTE: While it is not required that the signature be on the correct signature line, it does need to indicate an agreement/authorization of the items preceding the signature section on the signature page, i.e., the rights and responsibilities section of the application or review form.

Online Applications – In general the applicant (or applicant’s representative authorized to act on behalf of the applicant) should type his/her full name on the application, which constitutes a valid and acceptable signature. However, when less than the applicant’s (or authorized representative’s) full name appears, the following provisions apply. Acceptable – Using the prudent person concept described in 1310 , if the signature submitted on the application provides enough evidence to reasonably identify the signer as the applicant (or authorized representative), the signature is considered acceptable. Examples of acceptable signatures include (but are not limited to) the use of initials, nicknames, or partial names associated with that person instead of his/her legal name, as long as the identity of the signer can reasonably be discerned from the signature. Not Acceptable – If the signature provided on the application does not provide enough evidence to reasonably identify the signer as the applicant (or authorized representative), the signature is considered unacceptable. Examples of unacceptable signatures include (but are not limited to) partial names or nicknames not normally associated with the person’s formal name, an indecipherable combination of letters and/or numbers, or a name totally disassociated from the applicant. When the signature has been determined to be unacceptable, an attempt to contact the applicant should be made to confirm the identity of the person who signed the application. If it is confirmed that the applicant (or authorized representative) signed the application, the signature shall be considered acceptable.

Telephonic Applications – A person applying telephonically shall be required to verbally certify, under penalty of perjury, that they understand the questions and statements read to them, and that the answers are correct and complete to the best of their knowledge. To complete the telephonic signature, the applicant will be required to state their full legal name. That statement will be recorded and attached to the case as a permanent record. Based on this process, the verbal signature shall always be deemed to be acceptable. However, if it is later verified that the person who provided the verbal signature was not the applicant (or authorized representative), the signature is considered to be a forgery, and thus an invalid signature, see 1411.2 (6) . If the application does not contain an acceptable signature, follow the process described in 1411.2 (6) for invalid signatures.

NOTE: While the applicant (or authorized representative) is directed to both sign and date the application, failure to date the application (or provide an incorrect date) does not invalid the signature or the application. As long as an acceptable signature has been provided, the signature requirement has been met. See 1411.2 .