IM-074 AUTHORIZED REPRESENTATIVE FORM (IM-6AR) CLARIFICATION

FROM:                       PATRICK LUEBBERING, DIRECTOR

SUBJECT:                AUTHORIZED REPRESENTATIVE FORM (IM-6AR) CLARIFICATION

FORM REVISION #19

IM-6AR

 

DISCUSSION:

This memorandum provides updates to the Authorized Representative Form (IM-6AR)

The box containing the following statement pertains only to MO HealthNet:

  • If your authorized representative helps you apply, your authorization only last until the FSD makes a final decision on your application, or you can end it sooner if you notify the FSD in writing. If your authorized representative acts on your behalf, your authorization will last until you end it by notifying the FSD in writing.

NOTE:  For Food Stamps and Temporary Assistance, authorization for an authorized representative does not end at the final decision of the case. 

Child Care Subsidy will also use the IM-6AR form to appoint their authorized representatives.

The form has been updated to reflect the changes.

NOTE:  Continue to accept IM-6AR forms with a revision date of April 2017 or after.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Effective immediately begin using the IM-6AR with the 4-19 revision date.

 

PL/ks