Common Contracts
1 similar Authorized Representative Agreement contracts
Clear FormAuthorized Representative Agreement • December 7th, 2018
Instructions: The Employer of Record may choose to have someone help with their duties in the Virginia Consumer‐Directed Services Program. The Employer of Record role will not change if a Signatory Authority is used. A family member or friend can be in this role. CDCN cannot release information to anyone, unless they are listed on this form, due to Health Insurance Portability and Accountability Act (HIPAA) requirements. Only submit this form if you are choosing someone to help you with Employer duties.
