zz – Obsolete

0803.020.10.30 Authorized Representative Revocation – OBSOLETE

Obsolete per IM-103 July 11, 2022

IM#79 December 28, 2018, IM-33 April 20, 2015

The Appointment of Authorized Representative may be revoked at any time.

  • The applicant/participant or those legally acting on their behalf must complete the Authorized Representative Revocation (IM-6ARR) form or provide a signed and dated written request to revoke their appointment of an authorized representative.
  • The IM-6ARR or a written notice 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 is received by the FSD. Staff must enter the information in FAMIS or MEDES on the date the form is received.

NOTE: Upon receipt of a completed IM-6ARR or signed and dated written statement requesting revocation, update the Authorized Representative information on the Representative List screen (AUTHREP/FMJ1) and Representative Detail screen (FMJG) in FAMIS.

In MEDES, on the client’s Person Page under Notes make a comment of the receipt of the IM-6ARR. The comment should include the date the IM-6ARR is signed and received and that the applicant/participant has revoked the privileges of the authorized representative.