111.03 Authorized Representative (AR) Signature Required (MAM)

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The authorized representative (AR) assisting the individual must sign the:

• application form;

• DFA Form 778, Authorized Representative Declaration, or Appendix C of DFA Form 800MA, Application for Health Coverage & Help Paying Costs; and

• any other forms the AR assisted in completing.

If able, the individual must also sign or mark each form.