PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
the document
for the current year.
Authorization to Release Information - Arkansas
Authorization to Release Information is a legal document that was released by the Arkansas Department of Transformation and Shared Services - a government authority operating within Arkansas.
FAQ
Q: What is an Authorization to Release Information?
A: An Authorization to Release Information is a legal document that allows someone to share your private information with a specified person or organization.
Q: Why would I need an Authorization to Release Information?
A: You may need an Authorization to Release Information to allow someone to access your medical records, educational records, or other private information.
Q: Who can request an Authorization to Release Information?
A: Any individual or organization that you want to share your private information with can request an Authorization to Release Information.
Q: Do I need to sign an Authorization to Release Information in Arkansas?
A: Yes, you need to sign an Authorization to Release Information in Arkansas if you want to allow someone to access your private information.
Q: Can I revoke an Authorization to Release Information?
A: Yes, you can revoke an Authorization to Release Information at any time by notifying the person or organization who received it.
Q: Is there a fee for obtaining an Authorization to Release Information?
A: The cost for obtaining an Authorization to Release Information may vary depending on where you get it. Contact the relevant organization or agency for more information.
Form Details:
- Released on October 14, 2019;
- The latest edition currently provided by the Arkansas Department of Transformation and Shared Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas Department of Transformation and Shared Services.
