Authorized Agent

The Authorized Agent form is for members that wish to give permission to another individual, in order for that individual to take care of their Oneida Enrollment Department matters, with the exception of the OLIPP Beneficiary Form.

The member may revoke this decision in writing at any time.

The Authorized Agent request is only valid at the Oneida Enrollment Department, if the member needs to assign a representative to handle other matters (ex. Banking, Health Care) it is recommended that you obtain a Power of Attorney.

Authorized Agent Form (Adobe.PDF)