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AUTHORIZED REPRESENTATIVE FORM COMPLETE THIS FORM TO AUTHORIZE FAMILY AND FRIENDS TO CONTACT HSA ON YOUR BEHALF ALL SECTIONS MUST BE COMPLETED UNLESS OTHERWISE SPECIFIEDPART A: MEMBER INFORMATION
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The 0135-10988 privacy formsupdate authorization is a form used to authorize updates to privacy forms.
Anyone who needs to update privacy forms is required to file the 0135-10988 form.
To fill out the form, provide the requested information and sign where indicated.
The purpose of the form is to authorize updates to privacy forms.
The form may require information such as personal details and the specific updates being authorized.
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