State Employees' Leave Bank Program Authorization Form for Review of Released Records and Information - Maryland

State Employees' Leave Bank Program Authorization Form for Review of Released Records and Information - Maryland

State Employees' Leave Bank Program Authorization Form for Review of Released Records and Information is a legal document that was released by the Maryland Department of Budget and Management - a government authority operating within Maryland.

FAQ

Q: What is the State Employees' Leave Bank Program?
A: The State Employees' Leave Bank Program is a program that allows employees to donate and receive leave time in case of a personal or family medical emergency.

Q: What is the purpose of the Authorization Form for Review of Released Records and Information?
A: The purpose of the Authorization Form is to give consent for the release of an employee's medical records and information for the evaluation of their eligibility for the Leave Bank Program.

Q: Who should complete this form?
A: This form should be completed by employees who are applying to the State Employees' Leave Bank Program and need to have their medical records reviewed for eligibility.

Q: What information is requested in the Authorization Form?
A: The Authorization Form requests the employee's name, contact information, and consent to release their medical records and information for review.

Q: Is completing this form mandatory for participation in the Leave Bank Program?
A: Yes, completing the Authorization Form is mandatory for the evaluation of an employee's eligibility for the State Employees' Leave Bank Program.

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Form Details:

  • Released on April 1, 2018;
  • The latest edition currently provided by the Maryland Department of Budget and Management;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Maryland Department of Budget and Management.

Download State Employees' Leave Bank Program Authorization Form for Review of Released Records and Information - Maryland

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