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Maine Certificate Authorizing Release of Benefit Information

State:
Maine
Control #:
ME-SKU-0765
Format:
PDF
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Certificate Authorizing Release of Benefit Information

Maine Certificate Authorizing Release of Benefit Information is a document that is issued by the Maine Department of Health and Human Services (HHS) to authorize the release of confidential information regarding benefits received by an individual. The certificate is used to allow the release of information to other entities, such as creditors or employers, for the purpose of verifying benefits or establishing eligibility. There are two types of Maine Certificate Authorizing Release of Benefit Information: the Authorization for Release of Information (APRI) and the Authorization for Release of Benefit Verification (ABV). The APRI allows the release of information regarding an individual's eligibility for benefits, such as Social Security, Medicare, or unemployment benefits, while the ABV allows the release of information regarding the amount of benefits received. Both types of certificates must be signed by the individual and provided to HHS.

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What you get: Instant access to fillable Microsoft Word or PDF forms. Minimize the risk of using outdated forms and eliminate rejected fillings.THE EMPLOYEE AUTHORIZES THE RELEASE OF BENEFIT INFORMATION PURSUANT TO 39-A M.R.S.A. §221(5). The completed form should be faxed directly to Christina Randall,. Department of Labor, Bureau of Unemployment Compensation at 207-287-2305. Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an. Get VA Form 214142, Authorization to Disclose Information to the Department of Veterans Affairs (VA). Purpose: In signing this consent form, you are authorizing HUD and the above-named HA to request income information from the sources listed on the form. The information I am requesting is: ❑ Entire File. Complete this section, use the space provided in Part 6.

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Maine Certificate Authorizing Release of Benefit Information