Mention your name and a short description of who you are. Start the letter with a direct statement outlining why the authorization is necessary.Complete this form if you are authorizing a person to act on your behalf during a Screening Review or Hearing Review appointment. To exhibit this, Royal Sire, in a most extensive view, What is the reason of the nation being divided, and the one half at war with the other? Buckle up, because we're about to navigate the nuanced maze of copyrights and permissions! Blog Middle Component Image. Have back rent and need assistance? The letter outlines the waiver request process you must complete and submit. For example, your representative can authorize a medical procedure, sign legal documents in your absence, or withdraw funds from your bank. There is not a fee to apply for the Harris Health Financial Assistance Program.