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Support Broker Reauthorization Form Please complete the entire form, save the document, and submit the file to ODD. See page 3 for instructions. Section I: Identifying Information Last NameFirst NameMiddle
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To fill out the support broker reauthorization form, follow these steps:
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Start by downloading the support broker reauthorization form from the official website or obtaining it from the relevant organization.
03
Carefully read through the instructions provided with the form to understand the requirements and gather all the necessary information.
04
Begin filling out the form by providing your personal details such as name, address, contact information, and any other required identification information.
05
Fill in the specific details related to your support broker reauthorization, such as the start and end dates for the reauthorization period.
06
Provide information about the support broker by including their name, organization, contact details, and any other relevant information.
07
If required, provide additional information or documentation supporting your need for support broker reauthorization.
08
Double-check all the information you have entered to ensure accuracy and completeness.
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Sign and date the form as per the provided instructions.
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Submit the completed support broker reauthorization form through the designated method, such as mailing it to the appropriate address or submitting it online.
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Keep a copy of the filled-out form for your records and reference if needed in the future.

Who needs support broker reauthorization form?

01
Individuals who require support broker services and whose reauthorization period is expiring or has expired would need to fill out the support broker reauthorization form.
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The support broker reauthorization form is a document that allows individuals to renew their contract with a support broker for services.
Individuals who wish to continue receiving support services through a broker are required to file the support broker reauthorization form.
The support broker reauthorization form can be filled out online or through a paper application provided by the support broker. It requires personal information, service needs, and any changes in circumstances.
The purpose of the support broker reauthorization form is to ensure that individuals are still eligible for support services and that their needs are being met appropriately.
The form requires information on the individual's personal details, current support services being received, any changes in circumstances, and the need for continued support.
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