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Act on your behalf in all other matters with NY State of Health: The Official ... power of attorney form. ... State of Health at P.O. Box 11727, Albany, NY 12211.

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What is combined authorized representative designation?

Combined authorized representative designation is a form that allows multiple entities to designate a single representative for regulatory compliance purposes.

Who is required to file combined authorized representative designation?

Any group of entities that wish to designate a single representative for regulatory compliance purposes.

How to fill out combined authorized representative designation?

The form can be filled out online or submitted in hard copy, providing all necessary information about the entities and the designated representative.

What is the purpose of combined authorized representative designation?

The purpose is to streamline regulatory compliance by allowing multiple entities to designate a single representative.

What information must be reported on combined authorized representative designation?

Entities must provide details about their corporate structure, contact information, and the designated representative.

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