PD 407-159 Authorization for Release of Information indd 2025

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The document is an 'Authorization for Release of Information' form that allows the New York City Police Department to obtain personal and professional information about an individual from various agencies, including military, law enforcement, and educational institutions. The purpose is to assess the individual's suitability for employment as a Police Officer or Civilian Employee. The applicant can choose whether their current employer may be contacted and acknowledges the release of liability for the information disclosed.

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Click ‘Get Form’ to open the PD 407-159 Authorization for Release of Information in our editor.
Begin by entering your name in the designated field at the top of the form. This identifies you as the applicant authorizing the release of information.
In the authorization section, clearly indicate which agencies and institutions are permitted to share your information. Ensure all relevant entities are checked off for comprehensive coverage.
Decide whether you want your current employer contacted. Check 'Yes' or 'No' accordingly, and provide an explanation if you choose not to contact them.
Sign the form in the designated area to validate your authorization. Make sure to date it accurately.
If required, have a notary public witness your signature and complete their section at the bottom of the form.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (46 Votes)
2009	4.4 Satisfied (25 Votes)

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How to fill out an authorization for release of medical information?

Begin by specifying your name, the entity authorized to disclose information, and the individuals or entities you authorize to receive it. Indicate the specific information and purpose for which it will be disclosed, add an expiration date or event, and sign and date the form to confirm your consent.

How to fill out an authorization letter?

How do I write a simple letter of authorization? Start with your name and contact information at the top. Include the current date. Write the recipients name and contact information. Clearly state your name and that youre writing to grant authorization to another individual or organization.

How do you write an authorization letter for medical records release?

I, the undersigned, authorize the release of, or request access to the information specified below from the medical record(s) of the above name patient. I understand that my records are confidential and cannot be disclosed without my written authorization, except when otherwise permitted by law.

How do I give permission to share medical information?

Explicit consent It can be given in writing, verbally or through another form of communication, such as sign language.

What does a valid authorization for release of information contains?

The core elements of a valid authorization include: A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.