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Print and complete both parts of the authorization form below and return it with

Print and complete both parts of the authorization form below and return it with 2026

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The document is an authorization form for setting up automatic bill payments to PP&L, Inc. It requires customers to provide their account details, personal information, and a voided check or savings account information. By signing the form, customers authorize their financial institution to charge their specified account for monthly electric service bills and agree to the terms of the payment plan.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Bill Account Number as it appears on your electric bill. This ensures accurate processing of your payments.
Fill in your Phone Number, Name, Address, City, State, and ZIP code. Make sure these details match those on your electric bill for verification purposes.
If the name of the depositor differs from yours, provide that information in the designated field.
Select the type of account you are using by checking either 'A' for Checking Account or 'B' for Statement Savings Account. If you choose 'B', ensure you obtain your Account Number and ABA Routing Number from your financial institution.
Review the Prearranged Payments Authorization Agreement carefully. By signing and dating this section, you authorize your financial institution to process payments as specified.

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What is the purpose of release of information?

Release of information (ROI) is the process of providing access to protected health information (PHI) to an individual or entity authorized to receive or review it.

What is an authorization form used for?

An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

Where do I mail my CMS form 10106?

If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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