Authorization of Release of Information

Authorization of Release of Information Applicant should sign the “Authorization of Release of Information Form” (Form ARF-001) annually to authorize the energy vendor(s) to release household energy usage and billing data to the subgrantee for purposes of reporting this data in the LIHEAP Performance Measures Report required by the Department of Health and Human Services. The subgrantee shall advise the applicant that refusal to sign this form will prevent the subgrantee from being able to retrieve the applicant’s utility bills from the vendor. LIHEAP benefits cannot be denied to the applicant for refusal to sign this form. However, subgrantees must list the applicant’s name on a report to be submitted to MDHS requesting the applicant’s information not be included in the federal report.