The form authorizes release of information in accordance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164; 5 U.S.C. 552a; and 38 U.S.C. 5701 and 7332 that …

I understand that it is possible that information disclosed under the terms of the authorization may be re-disclosed by a recipient and no longer protected by HIPAA privacy standards.

Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an individual or group (for example, a doctor or an insurance company).

Form 433-F is used to obtain current financial information necessary for determining how a wage earner or self-employed individual can satisfy an outstanding tax liability.

Use this form to tell 1-800-MEDICARE who can access your personal health information. Whether you choose to share your personal health information or not has no effect on your enrollment, eligibility …

Do you confirm the accuracy of the information provided and consent for your data to be processed in line with data protection regulations?

PURPOSE: The primary purpose for providing the requested information on this form is to request access to information under the FOIA and/or PA, or amendment or correction of records under the PA.