1801.030.00 Revoking an Authorized Representative Appointment – DSS Manuals
IM-103 July 11, 2022
The participant may revoke an authorized representative’s status at any time.
The participant, or those legally acting on their behalf, must revoke the authorized representative status in writing, or they may complete the Authorized Representative Revocation (IM-6ARR) form.
The IM-6ARR or a written request may be received by mail, telephonically recorded (if available), or any commonly available electronic means.
The revocation of an authorized representative is effective the date the IM-6ARR or written request is received by Family Support Division (FSD). Staff must enter the information in the eligibility system.