Release of Information 448-01-25-15-30

Confidentiality information includes Individually Identifiable Information; Personally Identifiable Information (PII); Federal Tax Information (FTI); Protected Health Information (PHI).

An Authorization to Disclose Information form, SFN 1059, is required before Releasing Confidential Information. Eligibility workers MUST receive a supervisor’s approval before Releasing Confidential Information.

Confidential information the household has provided, or HHS has received for the purpose of determining eligibility for Economic Assistance and Health Care Coverage Programs, CANNOT BE RELEASED unless otherwise allowed by federal and state laws, federal regulations, and state administrative rules.

Generally, confidential information cannot be released to a third party without the written authorization of the applicant or recipient. There are a few exceptions:

1. A responsible adult non-household member authorized in writing by the household to act on behalf of the household (Authorized Representative). An Authorized Representative is associated with a client’s account via SFN 405, in the SSP, or via the SFN 1059, via Medicaid 1909 appendix c, or Medicaid 958.

    

2. A legal representative provided HHS Legal has reviewed and approved the request.

    

3. Or as designated in the SFN 405 for the purpose of conducting collateral contact to verify information related on the household or household members for the determination of eligibility for Economic Assistance Programs or Medicaid.

    

   The Confidential Information being released MUST never be an original. Verbal releases must only occur in an area and in a manner which protects confidential information. An Authorization to Disclose Information remains valid unless:

    

   • The release specifies an expiration date, or

   • The applicant, recipient, or a legal representative of an applicant or participant has revoked the Authorization to Disclose Information form.

    

Certain information cannot be released, even when the applicant, participant, or legal representative of an applicant or participant has signed an Authorization to Disclose Information form. SPACES Interface information CANNOT be released even when the applicant or participant has signed an Authorization to Disclose Information, see 448-01-25-10-05. Authorization to Disclose Information forms must follow the requirements in the Confidentiality Manual. If you have questions, please escalate to a supervisor before releasing any Confidential Information. Documents containing Confidential Information CANNOT be released. Instead, these documents must be withheld. Confidential Information that cannot be released includes:

• Internal Revenue Service (IRS): Information obtained from the Internal Revenue Service (IRS) is the property of the IRS and is identified as UFO and BENDEX Wage search results received through the IEVS Interface. It may only be used to determine eligibility, ongoing benefits or payments for Economic Assistance or Health Care Coverage Programs.

   

• Vital Statistics: Information obtained through the Vital Statistics Interface with the Public Health Division’s Vital Statistics Office is the property of the Vital Statistics Office. Information received through the Vital Statistics Interface may only be used to determine eligibility, ongoing benefits or payments for Economic Assistance or Health Care Coverage Programs.

   

• Job Service North Dakota: Information obtained through the Unemployment Insurance Benefits (UIB) Interface with Job Service North Dakota is the property of Job Service North Dakota and may only be used to determine eligibility, ongoing benefits or payments for Economic Assistance or Health Care Coverage Programs.

   

• Social Security Administration (SSA): Information obtained through Social Security Administration (SSA) Interfaces is the property of SSA and may only be used to determine eligibility, ongoing benefits or payments for Economic Assistance or Health Care Coverage Programs.

   

  Note:SSA information, with the exception of BENDEX Wage, received through the Interface may be released to the applicant or participant with a signed Authorization to Disclose Information but cannot be released to any other individual or agency. SSA information provided by the applicant or participant may be shared upon receipt of a signed Authorization to Disclose Information from the applicant or recipient.

   

• Information obtained through Systematic Alien Verification for Entitlement Program (SAVE): The information is received through an interface with the Department of Homeland Security and may only be used to verify immigration status of applicants and recipients who are not U. S. Citizen.