1802.000.00 Applications

1802.020.35 Signing by a Relative

IM-66 May 25, 2022; IM-134 November 14, 2017

If the participant is not capable of signing an application, due to physical or mental impairment, a relative who meets criteria shown in 1802.020.00 Signing the Application, may sign the application. Inform the relative that the applicant is responsible to ensure complete and correct information is provided on the application. Signatures for applications signed by relatives should be in the following format: (applicant first and last name) by (relative first and last name), (relationship)

EXAMPLE: Mary Jones is the mother of Jane Jones who is pregnant. Jane is in a medically induced coma and is unable to sign the application or appoint an authorized representative. Mary completes the application on Jane’s behalf.      

Mary should sign the application as follows –                 

Jane Jones by Mary Jones, mother of Jane.

NOTE: The designation of an authorized representative must be signed by the participant. Relatives cannot appoint an authorized representative on behalf of a participant.