Indiana § 12-20-7-1 Consent; form; filing

Indiana Statutes

§ 12-20-7-1 — Consent; form; filing

Indiana·Art. 20 TOWNSHIP ASSISTANCE·Ch. 7 Consent to Disclosure of Personal Information

(a)Each applicant and each adult member of the applicant's household seeking township assistance must consent to a disclosure and release of information about the applicant and the applicant's household before township assistance may be provided by the township trustee. The consent must be made by signing a form prescribed by the state board of accounts. The form must include the following:

(1)The applicant's name, case number, and address.

(2)The types of information being solicited, including the following:

(A)Countable income.

(B)Countable assets.

(C)Wasted resources.

(D)Relatives capable of providing assistance.

(E)Past or present employment.

(F)Pending claims or causes of action.

(G)A medical condition if relevant to work or workfare requirements.

(H)Any other information r

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(a) Each applicant and each adult member of
the applicant's household seeking township assistance must consent to
a disclosure and release of information about the applicant and the
applicant's household before township assistance may be provided by
the township trustee. The consent must be made by signing a form
prescribed by the state board of accounts. The form must include the
following:
(1) The applicant's name, case number, and address.
(2) The types of information being solicited, including the
following:
(A) Countable income.
(B) Countable assets.
(C) Wasted resources.
(D) Relatives capable of providing assistance.
(E) Past or present employment.
(F) Pending claims or causes of action.
(G) A medical condition if relevant to work or workfare
requirements.
(H) Any other information required by law.
(3) The names of individuals, agencies, and township trustee
offices that will receive the information.
(4) The expiration date of the permission to disclose information.
(b) Information that is declared to be confidential by state or federal
statute may not be obtained under the consent form prescribed by this
section.
(c) The township trustee shall keep on file and shall make available
to the division of family resources and office of Medicaid policy and
planning upon request a copy of the signed consent form described in
subsection (a).
(d) The township trustee shall send to the county office a copy of the
signed consent form described in subsection (a).
(e) The division of family resources, county offices, and the office
of Medicaid policy and planning shall make available to the township
trustee upon request a copy of signed consent to disclosure and release
of information forms in each entity's files.
(f) If an individual who is required to sign a form under this section
is unable to sign the form in the township trustee's office due to a
physical or mental disability or illness, the township trustee shall make
alternate arrangements to obtain the individual's signature.
[Pre-1992 Revision Citation: 12-2-13-1.]

Indiana § 12-20-7-1 (Consent; form; filing) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Legislative History

As added by P.L.2-1992, SEC.14. Amended by P.L.4-1993, SEC.193; P.L.5-1993, SEC.206; P.L.46-1995, SEC.57; P.L.51-1996, SEC.31; P.L.259-2001, SEC.5; P.L.73-2005, SEC.39; P.L.145-2006, SEC.115.