An individual is responsible for proving his or her statements. If the proof the individual provides is not good enough, not complete, or not consistent, he or she must cooperate with the CAO in getting other proof. 55 Pa. Code § 201.1
The applicant is expected to try to get proof from third parties. If the individual tries but cannot do it, the CAO can make collateral contacts.
The Authorization for Release of Information Form (PA 4) will only be used when:
The individual cannot give proof to show that he or she is eligible for MA.
The individual’s written consent is needed for information to be released.
If the PA 4 is needed at application or renewal, the following individuals must sign it:
The applicant no matter how old he or she is.
The payment name, no matter how old.
Any applicant or recipient age 21 or over.
Any applicant or recipient who is an emancipated minor.
If an individual does not sign the PA 4 when one is needed, the individual is ineligible for benefits. 55 Pa. Code § 201.4(2)(ii)
At application, the applicant may need to sign a PA 4. If the individual is unable to give all information needed to determine eligibility for MA, other individuals must sign the PA 4 within thirty calendar days of the date benefits are approved.
Exception: A signed PA 4 is not needed when a PA 600 CH or COMPASS application is used. Statements in the rights and responsibilities section of these applications allow the CAO to make collateral contacts. A signed PA 4 may still be needed for applications that use a PA 600. If the PA 600 application includes children, the PA 4 can be signed at the next client contact.
A family member who is added to an existing applicant/recipient group must sign a PA 4 within fifteen working days if the family member cannot give all the information needed to determine eligibility for MA.
At renewal, the individual completing the renewal may need to sign a PA 4. Other individuals must sign the PA 4 within fifteen working days if the PA 4 is needed.
The individual who is the payment name must sign a PA 4, if one is needed, within fifteen working days of a payment name change or a name change or after an intercounty transfer is completed if a written consent form is needed to determine continued eligibility for MA.
The PA 4 shows that an applicant agrees to let a third party give information about the applicant’s age, residence, citizenship, identity, employment, applications for employment, income, and resources. The CAO will keep the original copy of the signed PA 4 in the case record. The CAO will also give a copy of the form to any collateral contact who asks for written consent before giving information. 55 Pa. Code § 201.4(1) 55 Pa. Code § 201.4(2)(ii)
The use of outside sources of information should be planned, and the sources should be carefully chosen. The way that community contacts are chosen and used will affect the public assistance program, not only on a local level but statewide. Constant effort should be made to get and keep friendly and cooperative relationships with sources of information.
One important step in meeting this goal is a continuing program for improving current ways of getting information. In the end, only a minimum amount of time and effort will be needed to get information. People who are contacted sometimes say they are resentful of the information-gathering process if it is too time-consuming or if they have been asked the same questions before. Make sure the individuals who are contacted for information understand why the information is needed and that any information that they provide will not be given to anyone else. 55 Pa. Code § 205.1(b)
Updated February 14, 2012, Replacing October 29, 2008