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This person is called an "authorized representative. An Authorized Representative is a person you authorize to act on your behalf, in pursuing a claim or an appeal of a denied claim.Each representative must fill out a separate form. Complete if authorized representative is a person. To have someone else act on your behalf in an appeal, complete and return this form. The person listed will be accepted as your authorized representative. A completed Paid Family and Medical Leave designated authorized representative form;. Legally Authorized Representative Designation Letter. VCB–31–10004 (Rev. To have someone else act on your behalf on an appeal or grievance, complete and return this form.