Form GCI-1040A Consent to Share Early Intervention Records and Information - Arizona

What Is Form GCI-1040A?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form GCI-1040A?
A: Form GCI-1040A is a consent form for sharing early intervention records and information.

Q: Who needs to fill out Form GCI-1040A?
A: Parents or guardians of children receiving early intervention services in Arizona need to fill out this form.

Q: What is the purpose of Form GCI-1040A?
A: The purpose of this form is to give consent for sharing early intervention records and information with authorized individuals or organizations.

Q: Why is consent required for sharing early intervention records?
A: Consent is required to ensure privacy and confidentiality of the child's information and to comply with state and federal laws.

Q: What information is included in Form GCI-1040A?
A: Form GCI-1040A includes information about the child, parent or guardian, authorized individuals or organizations, and the duration of consent.

Q: How should I fill out Form GCI-1040A?
A: Read the instructions carefully and provide accurate information. Ensure all required fields are completed.

Q: Can I revoke my consent after submitting Form GCI-1040A?
A: Yes, you can revoke your consent at any time by submitting a written request to the early intervention program provider.

Q: What are the consequences of not completing Form GCI-1040A?
A: If you do not complete Form GCI-1040A, your child's early intervention records and information cannot be shared with authorized individuals or organizations.

Q: Is there a deadline for submitting Form GCI-1040A?
A: There may be a deadline imposed by the early intervention program provider. Contact them for specific information.