MSA Intake Analysis (Step 2)

Please print the Consent for Release of Information (SSA-3288), obtain the claimant's signature, and forward the signed form to Allsup. This will allow us to gather Medicare entitlement information from the Social Security Administration. If you have any questions, or would like additional information, please do not hesitate to contact us at (866) 477-7005 or e-mail us at msaservices@allsupinc.com. MSA Release Forms: http://www.allsupinc.com/Workers-Compensation/MSA-Release-Forms.aspx