Currently Approved Version of i3368 eAuthorization Screens

i3368 eAuthorization Screens - Current Version.pdf

Authorization to Disclose Information to the Social Security Administration

Currently Approved Version of i3368 eAuthorization Screens

OMB: 0960-0623

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i3368 screenshots
Medical Release Page

Yes path

No Path

Medical Release Form in popup window

Review

Submit

Receipt

Next Steps not from iClaim

Next Steps from iClaim

Overview not from iClaim

Overview from iClaim


File Typeapplication/pdf
File TitleMicrosoft Word - i3368 screenshots.doc
Author177717
File Modified2011-06-17
File Created2011-06-17

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