Us to request the fee be added to your case. How to submit a Student Award Authorization.NOTE: Read the Penalties section of the Form I-765. Instructions before completing this section. INSTRUCTIONS: Please read these instructions on how to complete the attached form. This Division provides assistance to residents, reviews permit applications, issues permits when proper, and inspects construction. This Consumer Disclosure and Authorization form, in original, faxed, photocopied, or electronic form, will be valid for any reports that may be requested by. Wayne County Hospital and Clinic System may impose a fee to cover the cost of labor, copying, postage, and preparing a summary of the requested information. Other Juvenile Matters. A template is available for your convenience.