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713 Chapter 3:Processes and procedures • Section 5: Program integrity (07/2026) The Authorization for Disclosure, Sharing and Use of Individual Information (MSC 3010) form is valid for one year, unless otherwise specified. It is advisable to limit their duration to the shortest period of time during which the release or exchange of information may occur. The release form should be provided in the appropriate native language or in an alternate format (Braille, large print, etc.) as necessary. Click here for Alternate formats. Oral authorization Except for health, treatment and domestic violence information, an oral authorization from the participant is sufficient to allow oral release of case record information specified by the participant to third parties. An oral authorization to release information to a third party is valid for a period of 30 days unless a shorter time period is given. The oral authorization should be narrated or documented in a case note. Non-ODHS|OHA authorization forms The use of a non-ODHS|OHA authorization form is permissible if the authorization contains all of the following information: • A description of the information to be disclosed that identifies the specific information • The identity of the person, classification of persons or ODHS|OHA program area authorized to make the disclosure • The identity of the person, classification of persons or entity to whom the information may be disclosed • The purpose of the disclosure • An expiration date or an expiration event, and • The dated signature of the individual, the individual’s attorney or the individual’s personal representative.

Š If the authorization is signed only by the individual’s personal representative, a description or explanation of the representative’s authority to act for the individual, including copies of any court documents appointing the personal representative, must be provided. What if the individual refuses to sign the authorization? An individual does not have to sign the release form and sometimes will refuse to sign a release form. The ODHS|OHA worker should talk through with the participant what specific objections they have to the release and why. It may also help to explain to the individual why it is helpful to ODHS|OHA to receive and share certain information about the individual. If, following that conversation, the individual still does not want to authorize disclosure of their information, The ODHS|OHA worker should explain to the individual that they are then responsible for providing any information that would have otherwise been obtained with the authorization. Failure to sign an authorization cannot be the basis for denying program services to otherwise eligible applicants. However, if the release of information is necessary to obtain documentation related to eligibility for the program, a denial would be based on the lack of required verification necessary to determine program eligibility and not on the refusal to sign the authorization.