Monday-Friday7:30 a.m.-5:30 p.m.
In order to speak on the behalf of, of gather any information about, the individual receiving benefits, you must get this authorized representative form signed and into the proper Human Services area.
Once filled out and signed, please scan and email the form to EMASintake@jeffco.us or fax to 303-271-4040.
To file a complaint of discrimination regarding a program receiving Federal financial assistance through the U.S. Department of Health and Human Services (HHS), write: HHS Director, Office for Civil Rights, Room 515-F, 200 Independence Avenue, S.W., Washington, D.C. 20201 or call (202) 619-0403 (voice) or (800) 537-7697 (TTY).
100 Jefferson County Parkway Golden, Colorado 80419 (303) 279-6511
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