IM-43 04/15/99 IM-6EBT FORM AND INSTRUCTIONS
|AUTHORIZATION FOR REFERRALS FOR PROACTIVE
FORMS MANUAL REVISION #13: IM-6EBT FORM, AUTHORIZATION FOR RELEASE OF INFORMATION FORM AND INSTRUCTIONS
|County offices recently implemented proactive
training plans targeted at elderly/disabled food stamp participants.
The plans focus on helping those participants who may need additional assistance
using EBT. Generally the plans stress training participants during
the application process and, when necessary, referring participants to
agencies or individuals who can provide follow-up assistance with using
the EBT card.
The IM-6EBT is developed to assist staff with the referral process. The participant signs this form authorizing the release of information regarding his/her situation to the agency/individual providing the assistance. A copy of the form is sent to each agency/individual listed who can provide assistance. The agency/individual records the action taken and returns the form once assistance is given to the participant.
The IM-6EBT form has been printed and an initial supply was sent to all county offices. Additional supply can be requested using normal supply request procedures.
Form not available on-line. Refer to IM Forms Manual.