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A Social Security Administration Consent for Release of Information, also known as Form SSA-3288, is a document that is used to provide official, written permission for a group such as a doctor, insurance company or any other group who may require specific information for a person, caregiver for an incompetent adult,
The office is listed under U. S. Government agencies in your telephone directory or you may call 1-800-772-1213 for the address. You may send comments on our estimate of the time needed to complete the form to: SSA, 1338 Annex Building, Baltimore, MD 21235-6401.
This is the form to use to get permission to obtain information and/or records from SSA about a claimant or beneficiary you do not represent. The claimant or beneficiary may give consent to an individual or an organization to obtain the information and records.
A specific description of the information to be used or disclosed, including the dates of service. The purpose of the requested use and disclosure. The expiration date or event. The patient signature and date.
The authorization form (sometimes called a patient HIPAA consent form), essentially serves as a handy dandy permission slip allowing a practice or business associate to use or disclose protected health information (PHI) in the ways a patient wants their data used.
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You can upload documents by using the Send Response for Individual Case link on the Electronic Records Express Home page. The upload function is also available while accessing a claimants electronic folder through the Access Claimants Electronic Folder link.
What Is 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.
Form SSA-89 is titled as an Authorization for the Social Security Administration (SSA) to Release Social Security Number (SSN) Verification. This form is used when certain sorts of business transactions, such as a credit check, must be performed. It is used to verify the social security number of the named individual.
The office is listed under U. S. Government agencies in your telephone directory or you may call 1-800-772-1213 for the address. You may send comments on our estimate of the time needed to complete the form to: SSA, 1338 Annex Building, Baltimore, MD 21235-6401.
YOU MUST SIGN, DATE, AND RETURN THE ENGLISH VERSION OF THE SSA-827 TO YOUR LOCAL SOCIAL SECURITY OFFICE TO HAVE YOUR DISABILITY CLAIM PROCESSED. WHOSE Records to be Disclosed - Please provide your first, middle, last name and suffix (if any), your social security number, and your birthdate.

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