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How to use or fill out Appointment of a Designated Representative CF-ES 2505 072013 with our platform
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Click ‘Get Form’ to open the Appointment of a Designated Representative CF-ES 2505 in the editor.
Begin by entering the case number and the customer's name in the designated fields. This information is crucial for identifying the specific case.
In the section labeled 'I would like for', input the name of the representative who will act on behalf of the customer regarding public assistance eligibility.
The customer must then sign and date the form, confirming their consent for the representative to act on their behalf.
Next, the representative should read and acknowledge their responsibilities by signing and dating where indicated. They must also provide their relationship to the customer, street address, city, state, and phone number.
If applicable, complete the self-appointment section by providing necessary details about why you are acting on behalf of the customer. Ensure all information is accurate before finalizing.
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Manager/Authorized Representative Authorized Representative: a person who is authorized to execute and file records with the Division of Corporations. Use AR. See 605.0102(8), F.S., for more information. A Manager or Authorized Representative may be an individual or business entity.
What does appointment of representative form mean?
(4) Authorized representative means an individual who has the legal authority to make decisions on behalf of a Medicaid recipient or potential Medicaid recipient in matters related to the managed care plan or the screening or eligibility process.
What is an authorized representative for Medicaid in Florida?
Designated representatives are individuals chosen to act on behalf of a company, organization, or person in specific matters. They may have authority to make decisions, sign documents, negotiate agreements, or communicate on behalf of the party they represent.
How to get someone on Medicaid in Florida?
Applications for Florida Medicaid Waiver services (financial eligibility) are processed by the DCF. You may go to the DCF Public Benefits Services website site or call DCF at 1- (866) 762-2237 for more information about Medicaid. All documents must be provided to DCF for financial eligibility determination.
What is the designation of an authorized representative?
Designations of Authorized Representative status for any present or future claim for health care benefits are more appropriately made to family members or other trusted persons who you may wish to authorize to assist you in the future with health care claim matters. Any present or future claim for health care benefits.
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When you authorize a representative, you are letting them represent you for your personal tax, business tax, non-resident tax, or trust tax matters. With authorization, your representative could do one or more of the following: access your personal tax information, tax assessment or reassessment.
What does the appointment of a designated representative mean?
Designated Representative means a person 18 years of age or over who is named by an employee for the purpose of caring for, escorting, or receiving monetary payments on behalf of a dependent.
Related links
Fla. Admin. Code Ann. R. 65A-2.022 | State Regulations
The following non-English versions of the Appointment of a Designated Representative form are incorporated by reference: CF-ES 2505H (Creole), 07/2013
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