M. POWER-OF-ATTORNEY, PRIVACY ACT RELEASE AUTHORIZATION
AND CHANGE OF CONTACT INFORMATION
Power-Of-Attorney
If an individual other than the applicant is submitting
and executing an application on behalf of the applicant,
it is mandatory that a copy of the notarized agreement granting
the individual current Power of Attorney to act on the applicant’s
behalf be submitted with the application materials.
Privacy Act Release Authorization
If an applicant wishes to authorize the Department of Health
and Human Services to disclose information relating to his/her
application (e.g., the status of the application) to a third
party (which would include, but is not limited to, an individual
to whom the applicant has granted power-of-attorney), the
applicant must complete and sign the Privacy Act Release
Authorization form.
Change of Contact Information
We frequently correspond with applicants by email. Please
make certain to disable SPAM blockers and check emails frequently
during the application process for correspondence from our
office. Notify us promptly, in writing, of any changes made
to in email address, mailing address or phone numbers.
next page: NHSC
LRP Checklist
Questions? nhsc@discoverylogic.com
or 1-800-638-0824 Monday through Friday (except Federal
holidays) 8:30 am to 5 pm ET.
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