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BAM 110 14 of 28 APPLICATION FILING AND REGISTRATION BPB 2025-003 1-1-2025

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

A person disqualified due to Intentional Program Violation cannot be an AR unless there is no responsible group member or anyone else available. Medical Information Acknowledgment All Programs When the AR completes the application, give or send the client a DHS-4609, Medical Information Acknowledgment, to sign. The DHS-4609 tells the client that MDHHS may share medical information for purposes of eligibility determination and program administration. If clients are unable to sign the DHS-4609 and their condition is such that medical information might need to be shared, refer the AR to Adult Services. Note: If the form remains unsigned, there is no penalty and eligibility determinations must not be delayed. OTHER AUTHORIZED REPRESENTATIVE FUNCTIONS FAP Only An AR may make food purchases from the FAP benefits account using the Bridge card. There is no age requirement for the AR who uses the group’s FAP benefits on behalf of the group. Note: This can be a different person than the AR who applies for benefits on the group's behalf. Enter on the Alternate Payee/Authorized Representative screen in Bridges the name of the person who is authorized to purchase food for the group and indicate the Type of Authorized Representative. The authorized representative’s name will appear on the Bridge card followed by Food Stamp Authorized Representative (FSAR).

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Page 14

Official source

BAM 110 14 of 28 APPLICATION FILING AND REGISTRATION BPB 2025-003 1-1-2025

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

A person disqualified due to Intentional Program Violation cannot be an AR unless there is no responsible group member or anyone else available. Medical Information Acknowledgment All Programs When the AR completes the application, give or send the client a DHS-4609, Medical Information Acknowledgment, to sign. The DHS-4609 tells the client that MDHHS may share medical information for purposes of eligibility determination and program administration. If clients are unable to sign the DHS-4609 and their condition is such that medical information might need to be shared, refer the AR to Adult Services. Note: If the form remains unsigned, there is no penalty and eligibility determinations must not be delayed. OTHER AUTHORIZED REPRESENTATIVE FUNCTIONS FAP Only An AR may make food purchases from the FAP benefits account using the Bridge card. There is no age requirement for the AR who uses the group’s FAP benefits on behalf of the group. Note: This can be a different person than the AR who applies for benefits on the group's behalf. Enter on the Alternate Payee/Authorized Representative screen in Bridges the name of the person who is authorized to purchase food for the group and indicate the Type of Authorized Representative. The authorized representative’s name will appear on the Bridge card followed by Food Stamp Authorized Representative (FSAR).