Authority to Release Personal Information to a Designated Individual (IMM 5475)
Download the form
How to download, save and open this form
- Use your computer. The form may not open on tablets or mobile phones.
- Save the form on your computer in a place you can remember.
- For most Internet browsers, clicking on the link above will automatically download the form.
- If the form doesn’t automatically download, right-click on the link and select “Save as.”
- After you download the form, open it using Adobe Acrobat Reader.
Open this form in Acrobat Reader
- Open Acrobat Reader.
- You need Acrobat Reader version 10 or higher to open our forms.
- Get the latest version of Acrobat Reader.
- Select “File” from the top menu.
- Click “Open.”
- Find the location where you saved the form, click on the file, and click “Open.”
When to use this form
Use this form if you want to allow us to give your personal information, such as the status of your application, to someone who will not act as your representative.
Paper applications
- If you haven’t submitted your application: include the form in your application package and send it to the address listed in your instruction guide.
- If you have already submitted your application: send us the form electronically through this Web form
Online applications
- If you haven’t submitted your application: upload this form along with your online application.
- If you have already submitted your application: send us the form electronically through this Web form