Form GCI-1040A Consent to Share Early Intervention Records and Information - Arizona

What Is Form GCI-1040A?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form GCI-1040A?A: Form GCI-1040A is a consent form used in Arizona to share early intervention records and information.

Q: What is the purpose of Form GCI-1040A?A: The purpose of Form GCI-1040A is to obtain consent from a parent or legal guardian to share early intervention records and information.

Q: Who needs to fill out Form GCI-1040A?A: Form GCI-1040A needs to be filled out by a parent or legal guardian of a child receiving early intervention services in Arizona.

Q: What information is required on Form GCI-1040A?A: Form GCI-1040A requires the parent or legal guardian's name, contact information, and the child's name and date of birth.

Q: Is Form GCI-1040A mandatory?A: No, Form GCI-1040A is not mandatory, but it is necessary to provide consent for sharing early intervention records and information.

Q: Can I revoke my consent after submitting Form GCI-1040A?A: Yes, you can revoke your consent at any time by submitting a written request to the early intervention program provider.

Q: How long is the consent valid on Form GCI-1040A?A: The consent provided on Form GCI-1040A is valid for one year, unless revoked earlier by the parent or legal guardian.

Q: Who can access the shared records and information?A: Only authorized individuals involved in the provision of early intervention services for the child can access the shared records and information.

Q: Is the shared information protected?A: Yes, the shared information is protected under federal and state confidentiality laws, such as the Individuals with Disabilities Education Act (IDEA).