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Instructions for Form DHS1121A Agreement to Act as an Authorized Representative - Hawaii
This document contains official instructions for Form DHS1121A , Agreement to Act as an Authorized Representative - a form released and collected by the Hawaii Department of Human Services. An up-to-date fillable Form DHS1121A is available for download through this link.
FAQ
Q: What is Form DHS1121A?
A: Form DHS1121A is the Agreement to Act as an Authorized Representative specific to Hawaii.
Q: Who should use Form DHS1121A?
A: Form DHS1121A should be used by individuals who want to act as authorized representatives for someone applying for benefits in Hawaii.
Q: What is the purpose of Form DHS1121A?
A: The purpose of Form DHS1121A is to establish an agreement between the applicant and their authorized representative regarding the representation.
Q: Are there any fees associated with submitting Form DHS1121A?
A: No, there are no fees associated with submitting Form DHS1121A.
Q: What information do I need to provide on Form DHS1121A?
A: You need to provide your personal information, including your name, address, and contact details, as well as the applicant's information and a declaration of your responsibilities as an authorized representative.
Q: Can I appoint more than one authorized representative?
A: Yes, you can appoint more than one authorized representative, but each representative must fill out a separate Form DHS1121A.
Q: What should I do with the completed Form DHS1121A?
A: You should submit the completed Form DHS1121A to the appropriate DHS office in Hawaii.
Q: Can the authorized representative make decisions on behalf of the applicant?
A: Yes, the authorized representative has the authority to make decisions on behalf of the applicant, as specified in the agreement.
Q: How long does it take to process Form DHS1121A?
A: The processing time for Form DHS1121A may vary, but you will be notified of the decision within a reasonable timeframe.
Instruction Details:
- This 1-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Hawaii Department of Human Services.
