Instructions for Form ODM06723 Designation of Authorized Representative - Ohio

Form ODM06723 Designation of Authorized Representative - Ohio

This document contains official instructions for Form ODM06723 , Designation of Authorized Representative - a form released and collected by the Ohio Department of Medicaid. An up-to-date fillable Form ODM06723 is available for download through this link.

FAQ

Q: What is Form ODM06723?
A: Form ODM06723 is the Designation of Authorized Representative form for Ohio.

Q: Who should use Form ODM06723?
A: This form should be used by individuals who want to designate someone to act as their authorized representative for Ohio.

Q: What is an authorized representative?
A: An authorized representative is a person who has legal authority to act on behalf of another individual in matters related to Ohio.

Q: What information is required to complete Form ODM06723?
A: To complete the form, you will need to provide your personal information, as well as the information of your authorized representative.

Q: How should I submit Form ODM06723?
A: You can submit the completed form by mail, fax, or in person to the Ohio Department of Medicaid or the local Medicaid office.

Q: Is there a deadline for submitting Form ODM06723?
A: There is no specific deadline for submitting the form, but it is recommended to submit it as soon as possible.

Q: Can I change my authorized representative?
A: Yes, you can change your authorized representative at any time by completing a new Form ODM06723.

Q: Are there any fees associated with Form ODM06723?
A: No, there are no fees associated with submitting or updating the form.

Q: What should I do if I have additional questions?
A: If you have additional questions, you can contact the Ohio Department of Medicaid or the local Medicaid office for assistance.