This form authorizes Canada Revenue Agency to release income tax return information of a resident to Manitoba Health, Seniors and Active Living. This form is used by Manitoba Health, Seniors and Active Living to determine and verify a resident's and their spouse's annual income, and to determine the resident's entitlement to a reduced residential/authorized charge. The form is applicable to Manitoba Health, Seniors and Active Living, Canada Revenue Agency, personal care home facilities and those residents applying for a reduced residential charge and their families/representatives. The form is filled out by the personal care home resident or their representative and by the personal care home facility. The form is processed by Manitoba Health, Seniors and Active Living and by Canada Revenue Agency.