Form MDHHS-5913 Authorization to Release Wic Information - Michigan

Form MDHHS-5913 Authorization to Release Wic Information - Michigan

What Is Form MDHHS-5913?

This is a legal form that was released by the Michigan Department of Health and Human Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is MDHHS-5913?
A: MDHHS-5913 is the authorization form used in Michigan to release WIC information.

Q: What is WIC?
A: WIC stands for Women, Infants, and Children. It is a nutrition program that provides support to low-income pregnant women, new mothers, and young children.

Q: Who can use MDHHS-5913?
A: MDHHS-5913 can be used by individuals who participate in the WIC program and need to authorize the release of their information.

Q: Why would someone need to release WIC information?
A: Someone might need to release WIC information to authorize the sharing of their WIC data with a specific individual or organization.

Q: Is there a cost to use MDHHS-5913?
A: No, there is no cost to use MDHHS-5913. It is a free form provided by the state of Michigan.

Q: How long does the authorization on MDHHS-5913 last?
A: The authorization on MDHHS-5913 lasts for a specified period of time, as indicated on the form.

Q: Can MDHHS-5913 be used to release any other type of information?
A: No, MDHHS-5913 is specifically for authorizing the release of WIC information only.

Q: What happens if I don't fill out MDHHS-5913?
A: If you don't fill out MDHHS-5913, your WIC information will not be shared with anyone other than those authorized by law.

Q: Can MDHHS-5913 be revoked?
A: Yes, the authorization on MDHHS-5913 can be revoked at any time by submitting a written request to the appropriate WIC agency.

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Form Details:

  • Released on March 1, 2021;
  • The latest edition provided by the Michigan Department of Health and Human Services;
  • Easy to use and ready to print;
  • Available in Arabic;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form MDHHS-5913 by clicking the link below or browse more documents and templates provided by the Michigan Department of Health and Human Services.

Download Form MDHHS-5913 Authorization to Release Wic Information - Michigan

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  • Form MDHHS-5913 Authorization to Release Wic Information - Michigan, Page 1
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