PRINT NAME OF STUDENT. Last. Name. Address. Kindly feel free to contact me in case you need any further information.Thank you very much for your kind cooperation. I have authorization to apply for Medicaid on behalf of the applicant. New York State Unified Court System. Attach a letter indicating changes to your account to the new authorization form. Please accord your letter to your situation and your mission. If you choose No Fee, you must have submitted a No Fee Authorization Letter as one of your documents in order to complete the payment process.