Withdrawal of Consent for Automated Income Verification with the Canada Revenue Agency –Long-Term Care Rate Reduction Program

Please complete this form if you wish to withdraw your consent to the Ministry of Long-Term Care (MLTC), Ministry of Finance and the Long-Term Care Home Licensee (LTCH Licensee) collecting your income information from the Canada Revenue Agency (CRA) using an Automated Income Verification (AIV) service for the purpose of MLTC assessing and administering your Application for Reduction in Long-Term Care Home Basic Accommodation (Application).

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Form Number 5083-69
Title Withdrawal of Consent for Automated Income Verification with the Canada Revenue Agency –Long-Term Care Rate Reduction Program
Description Please complete this form if you wish to withdraw your consent to the Ministry of Long-Term Care (MLTC), Ministry of Finance and the Long-Term Care Home Licensee (LTCH Licensee) collecting your income information from the Canada Revenue Agency (CRA) using an Automated Income Verification (AIV) service for the purpose of MLTC assessing and administering your Application for Reduction in Long-Term Care Home Basic Accommodation (Application).