Release of Information 448-01-25-15-30

Release/Disclosure of Information 448-01-25-15-30-05

(Revised 3/1/12 ML #3304)

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In addition to purposes directly related to the administration of the Economic Assistance and Health Care Coverage programs, information concerning recipients may be released upon receipt of a signed Release of Information via SFN 970 - Multi-Agency Authorization to Disclose Information or SFN 1059 - Authorization to Release Information with the exception of Confidential Information that Must Not be Released at 448-01-25-10-05.

When a Release of Information is completed, the following information must be included:

• The name of the agency releasing the information;

• Who the information will be released to (name of agency or person);

• What specific information the recipient wants to release;

• What the information being released will be used for; and

• The date the recipient wants the release to expire.

The recipient determines the length of time a Release of Information is in effect. Time restriction cannot be imposed on the release of information if the recipient wishes to leave it open-ended. (The length of time may be days, weeks, months, years, a specific event terminating the release, or until the case closes.) The Release of Information automatically ends when the case closes. Upon reapplication, a new Release of Information must be obtained.

Recipients must be provided with a signed copy of any Release of Information.

If an individual is not sure they should be releasing information, the rule to follow is to request a Release of Information before disclosing any kind of information the household has provided for the purpose of determining eligibility for Economic Assistance and Health Care Coverage Programs.