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Form ODM06723 Designation of Authorized Representative - Ohio
What Is Form ODM06723?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form ODM06723?
A: Form ODM06723 is the Designation of Authorized Representative form for Ohio.
Q: What is the purpose of Form ODM06723?
A: The purpose of Form ODM06723 is to designate an authorized representative to act on behalf of an individual or a minor in Ohio.
Q: Who can file Form ODM06723?
A: An individual or a parent or legal guardian of a minor can file Form ODM06723 in Ohio.
Q: Is there a fee to file Form ODM06723?
A: No, there is no fee to file Form ODM06723 in Ohio.
Q: What information is required on Form ODM06723?
A: Form ODM06723 requires information about the authorized representative, the individual or minor they will represent, and the specific powers granted to the representative.
Q: How long is Form ODM06723 valid?
A: Form ODM06723 is valid for one year from the date it is signed.
Q: Can Form ODM06723 be revoked?
A: Yes, the individual or the parent or legal guardian of a minor can revoke Form ODM06723 at any time by submitting a written request to the Ohio Department of Medicaid.
Q: Is Form ODM06723 only for Medicaid purposes?
A: Yes, Form ODM06723 is specifically used for Medicaid purposes in Ohio.
Q: Is there a deadline for filing Form ODM06723?
A: There is no specific deadline for filing Form ODM06723, but it is recommended to submit the form as soon as possible to ensure timely representation.
Form Details:
- Released on May 1, 2017;
- The latest edition provided by the Ohio Department of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form ODM06723 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
Download Form ODM06723 Designation of Authorized Representative - Ohio
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