8 Authorization to Release Information Form - NHSC - HRSA 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your full name in the designated field at the top of the form. Ensure accuracy as this information is crucial for identification.
3. In the first authorization section, provide your name, address, and social security number. This information allows the Department of Health and Human Services (HHS) to assess your eligibility for the NHSC Loan Repayment Program.
4. Next, fill out the second authorization section with similar personal details required for lenders/holders of your educational loans. This ensures they can verify your loan payoff balances.
5. Continue to complete sections three and four, where you will authorize HHS to release your information for compliance checks against various databases.
6. If applicable, include any health profession service obligations in section five. This helps HHS understand any additional commitments you may have.
7. Finally, sign and date the form at the bottom. Make sure that all fields are filled accurately before submitting.

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