SFN 970, Multi-Agency Authorization to Disclose Information 400-19-165-105

(Revised 6/1/10 ML #3218)

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The purpose of the SFN 970 is to request information on a specific individual from multiple agencies. Information requested must be required to determine eligibility and benefit level.

 

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms. (166kb pdf)

Note: E-Forms are presented in Adobe Acrobat and require the Adobe Acrobat reader. If you do not currently have Adobe Acrobat reader installed, you may download a free copy by clicking the Get Adobe Reader icon below.