Medicare Compensation Recovery Third party authority form (MO021)

Use this form to give us permission to release your compensation information or to give permission to a third party to sign relevant documentation on your behalf.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 19 July 2018