Ma designation 2026

1. Click ‘Get Form’ to open the Authorized Representative Designation Form in the editor.
2. In Section I, Part A, enter your name, social security number (if applicable), email address, and date of birth. Sign and date the form to certify your choice of authorized representative.
3. In Part B, the authorized representative must provide their name, phone number, mailing address, and sign to confirm their commitment to confidentiality.
4. If you cannot designate an authorized representative in writing, complete Section II by providing your information and having a responsible person sign as your representative.
5. For legal representatives, fill out Section III with the necessary details and attach a copy of the legal document that grants authority.
6. Review all sections for accuracy before submitting. You can send the completed form via mail or fax as instructed at the end of the document.

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