Model Authorization Form for Certified Application Counselors (CACs) in a Federally-facilitated Marketplace(Marketplace)
Guidance for Model form provided by CMS for use by certified application counselors (CACs) and CAC designated organizations (CDOs) in the Federally-facilitated Exchanges (FFEs) to facilitate obtaining authorization from a consumer prior to obtaining access to a consumer's personally identifiable information (PII).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 18, 2017
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.