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Texas Income Protection Plan for State Employees, ERS

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Authorization to Share Information with Family Member Form

The Authorization to Share Information with Family Member Form allows us to speak with a family member on your behalf to provide information regarding your disability claim. You must sign and date the Authorization Form before we can release any details of your claim. The original form must be completed and signed by you and faxed or mailed to TIPP Customer Care (fax number and address are shown on the form).


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