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AUTHORIZATION AND ASSIGNMENT I, ___, hereby authorize Springfield Clinic (Springfield Clinic or the Clinic) to use and disclose my medical information as set forth in the Clinics Notice of Privacy

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Fill out the 8158 form with accurate information regarding the authorization and assignment.

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Provide all required details such as name, address, social security number, and signature.

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Who needs 8158 authorization and assignment?

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Contractors who are working on a federal aid construction project funded by the Federal Highway Administration (FHWA) may need to fill out the 8158 authorization and assignment form.

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What is 8158 authorization and assignment?

8158 authorization and assignment is a form required by the Internal Revenue Service (IRS) for the authorization and assignment of a taxpayer identification number (TIN) by a third party.

Who is required to file 8158 authorization and assignment?

Any third party that needs to authorize or assign a TIN on behalf of a taxpayer is required to file 8158 authorization and assignment.

How to fill out 8158 authorization and assignment?

To fill out 8158 authorization and assignment, the third party must provide their information, the taxpayer's information, and the reason for the authorization or assignment.

What is the purpose of 8158 authorization and assignment?

The purpose of 8158 authorization and assignment is to ensure that the correct TIN is authorized and assigned to the taxpayer by a third party.

What information must be reported on 8158 authorization and assignment?

The information reported on 8158 authorization and assignment includes the name and address of the third party, the name and TIN of the taxpayer, and the reason for the authorization or assignment.

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