*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: June 1, 2012 |
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07.15.05 - Application Signature |
Archived: June 1, 2016 (Previous Versions) |
Specific signatures are required to consider an application complete. This section provides policy on who is required to sign an application and what to do if a signature is missing.
ApplyMN Electronic Signatures.
ApplyMN and Authorized Representative Signature Requirements.
Client Unable to Provide Signature.
Follow these rules when determining which signatures are required:
l A spouse may sign on behalf of his or her spouse.
l The primary applicant under age 18, including emancipated minors, for households consisting only of people under age 18 who are applying on their own behalf must sign the application.
l A parent, stepparent, other relative caretaker, or guardian may sign on behalf of 18, 19 and 20-year-olds living in their household. However, 18, 19 and 20-year-olds may also sign on their own behalf.
l One parent, stepparent, other relative caretaker, or guardian for households consisting of adults and children who are applying for the children under age 18.
Example:
John and Barbara apply for health care for themselves and their twins, age nine. John completes and signs the application.
Action:
John's signature completes the application for himself, his spouse and his children.
l Authorized representatives may sign the application on behalf of a household. A person cannot serve as an authorized representative if the household has not previously designated the person as an authorized representative. See Authorized Representatives for more information on how to designate an authorized representative.
Note: Do not require the authorized representative’s signature to consider the application complete if the applicant signature requirements are met.
l Applicants age 18 or older at the time the application is processed must sign the application unless someone who can sign on their behalf has signed the application.
Example:
Seri, age 18, applies for health care for herself and her mother, Kelly. Seri signs the application.
Action:
Seri cannot sign on behalf of her mother. Require Kelly to sign the application. Send MHCP Application Signature Page (DHS-3417A) with the Request for Information (DHS-3271) to collect Kelly’s signature.
Example:
Rosi applies for MHCP for herself and her husband, and her 22-year-old son, Eli. Rosi signs the application.
Action:
Rosi’s signature completes the application signature requirements for Rosi's household, which includes herself and her husband. Rosi's husband's signature is not required. However, Eli must sign the application since he is age 22 and Rosi cannot sign on his behalf. Create a separate case for Eli and send MHCP Application Signature Page (DHS-3417A) with Request for Information (DHS-3271) to collect Eli’s signature.
Example:
Christopher and Ana are unmarried, but live together with their two children. Ana completes an application for the four of them and signs the application.
Action:
Ana’s signature completes the application for herself and their children. However, since she and Christopher are not married, she cannot sign on his behalf. Send MHCP Application Signature Page (DHS-3417A) with the Request for Information (DHS-3271) to collect Christopher’s signature.
ApplyMN requires the applicant to sign electronically by typing his or her name in the "name field" and attesting (using the checkbox provided) they understand the electronic signature has the same legal effect as a written signature. ApplyMN only allows one person to sign the application electronically.
The electronic signature is a legally valid signature. Accept the electronic signature as entered on ApplyMN, if the name and spelling entered reasonably represents one of the allowable applicant signees in the household.
Determine if the correct person signed the application and whether additional signatures are required. Mail the appropriate form to collect the additional signatures if additional signatures are required to complete the application or to designate an authorized representative.
Example:
Mary Johnson, recently married, submitted an application for MA with ApplyMN. In the household information section, she indicated her name was "Mary Johnson," her new married name. However, she typed her maiden name, "Mary Anderson" in the signature box
Action:
The signature does not reasonably represent the applicant's name since the last names are completely different. Clarify with the applicant why the signature does not match. Send Mary the MHCP Application Signature Page (DHS-3417A) with the Request for Information (DHS-3271) to collect her signature.
Example:
Same as above, except Mary enters her married name in the signature box with a typo ("Mary Johhson").
Action:
The signature reasonably represents the applicant's name. Accept the signature.
Community partners, social workers, Multilingual Referral Line liaisons and other people who are completing an application with ApplyMN on behalf of applicants who are not physically present have two options for electronically signing and submitting the application:
1. The application assistor may enter "Did Not Sign" in the signature box. This will allow ApplyMN to submit the application and the processing agency will follow-up to obtain the needed signature.
2. The application assistor enters everything up to the Disclosure Screen and then saves the partially completed application and logs out. The applicant must then log in to their account, open the partially completed application, check the disclosure boxes, enter their name in the signature box and submit the application
ApplyMN and Authorized Representative Requirements
ApplyMN only allows one electronic signature on the application. Therefore, follow-up may be required to either complete the authorized representative designation or to complete the application.
l The applicant or the authorized representative may electronically sign the application if the person named on the application as an authorized representative has previously been designated as an authorized representative. No additional signatures are required.
l If the person named on the application as an authorized representative has not previously been designated as an authorized representative, and the applicant signs the application, then the applicant’s signature completes the application; however, the authorized representative’s signature is required to complete the authorized representative designation. Send the applicant the MHCP - Giving Permission for Someone to Act on My Behalf (DHS-3437)or MFPP - Giving Permission for Someone to Act on My Behalf (DHS-3437A) to obtain the authorized representative’s signature.
l Neither the authorized representative designation nor the application are complete if the person named on the application as an authorized representative has not previously been designated as an authorized representative and that person signs the application and the applicant does not sign the application. The applicant’s signature is required to complete the authorized representative designation and to complete the application. Send the MHCP Application Signature Page (DHS-3417A) with the Request for Information (DHS-3271) for the applicant to sign.
See Authorized Representatives for more information on designating an authorized representative.
Client Unable to Provide Signature
People who are mentally competent but unable to sign the application due to physical or other limitations may sign by making a distinct mark, such as an "X". Two witnesses must sign and date the application to verify that the person making the mark is indeed the person who is applying.
Appoint an authorized representative for applicants who are incapacitated or incompetent and cannot sign the application or designate an authorized representative.
When a required signature is not provided, follow these steps:
1. Pend applications for applicants who are required to sign the application but have not done so.
n Pend unsigned MA applications on PND2 in MAXIS until the end of the processing period.
n Pend unsigned MinnesotaCare applications as "P-30" (Incomplete application) on RELG and add reason code 04 (Need signature/date on App) on RIND. This may take place on first handling of the MinnesotaCare application or after a previous P-25 (pending other) coding on RELG.
2. Send the Health Care Applications (HCAPP) Signature Page (DHS-3417A) with the Request for Information (DHS-3271) to obtain the missing signatures.
3. Deny eligibility for applicants who are required but did not sign the application and did not return the DHS-3417A by the end of the processing period.
See the following for more information: