Nevada Authorized Representative Form 2525-EE for Medicare Savings
Why You Need Form 2525-EE
If you're an adult child trying to help your parent apply for a Medicare Savings Program in Nevada, DWSS will not talk to you until you have legal authorization on file. You cannot call to check your parent's application status, discuss their income verification, or receive their notices of decision. Sharing your parent's Access Nevada login credentials violates state security policies and isn't a workaround.
Form 2525-EE — the Designation of Authorized Representative — is the document that gives you standing with DWSS. Once it's filed and accepted, you can sign applications on your parent's behalf, speak with eligibility staff about the case, and receive copies of decision notices.
What Form 2525-EE Is Not
It's not a power of attorney. A general financial or medical POA gives you legal authority over your parent's affairs broadly, but DWSS has its own form that must be filed in the applicant's master electronic case record. If you already have a POA, DWSS will accept it — but you still need to submit a copy to be attached to the case. The POA alone doesn't automatically grant you DWSS access.
It's also not an SSA Representative Payee designation. Being your parent's representative payee means you manage their Social Security payments. It gives you zero authority over their Nevada Medicaid or MSP case. These are separate systems with separate authorization requirements.
How to Complete and Submit It
Form 2525-EE requires both the applicant (your parent) and the designated representative (you) to sign. Your parent is authorizing DWSS to share their case information with you and to accept your signature on documents filed on their behalf.
The form asks for:
- The applicant's name, case number (if they have one), and contact information
- The authorized representative's name, relationship, address, and contact information
- Signatures from both parties
If your parent cannot physically sign due to a medical condition, contact DWSS before submitting the form to confirm what signature or documentation it will accept.
Submission options:
- Attach it to the Access Nevada online application (if the portal allows — it often doesn't handle attachments cleanly)
- Fax to Southern Nevada at (702) 486-1634 or Northern Nevada at (775) 448-5094
- Mail to DWSS Processing Center, P.O. Box 15400, Las Vegas, NV 89114-5400
- Drop it off at any DWSS district office
Submit Form 2525-EE at the same time as the MSP application. If DWSS processes the application first and sends a verification request to your parent before your representative form is on file, you may not be able to respond on their behalf by the due date on the notice.
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Out-of-State Adult Children
Many Nevada seniors have adult children living in California, Utah, or Arizona. The authorized representative process works regardless of where you live — you don't need to be a Nevada resident to be designated on Form 2525-EE. But managing the case remotely means you're relying on fax, mail, and phone. Make sure your contact information on the form is current so DWSS sends copies of notices to your address as well as your parent's.
The Nevada Medicare Savings Programs & Extra Help Guide walks through the authorized representative process alongside the full application workflow, including what to do when DWSS sends verification requests and how to handle the case if your parent's condition changes mid-application.
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Download the Nevada — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.