Fill and Sign Legal Forms and Templates

This document is used to notify the authorities about a change in address for residents of New York who speak Bengali.

You should complete this form if to report the death of a person to a funeral director.

This form is used for giving consent to transfer Medi-Cal benefits to Healthy Families in California. (Spanish)

This Form is used for obtaining consent to transition from Medi-Cal to Healthy Families program in California, but it is specifically in the Korean language.

This form is used for property screening questions in California in the case of Sneede v. Kizer.

This Form is used for enrolling pregnant women, infants, and children in federal poverty level (FPL) programs in California. It includes income disregards for different age groups, such as 200 percent for pregnant women and infants, 133 percent for children ages 1 through 5, and 100 percent for children ages 6 through 18.

This Form is used to determine the income eligibility for QMB/SLMB/QI Medicare beneficiaries in California who are either couples or applicants with an ineligible spouse, with or without child(ren).

This form is used for determining the percentage obligation for Medi-Cal special treatment programs in California.

This form is used for calculating property eligibility for QMB, SLMB, and QI programs for adults aged 18 and older or married individuals in California.

This form is used for applying for the Medi-Cal Property Assessment program in California.

This Form is used for allocating funds from an SSI or IHSS person in California.

This form is used for giving consent to bridge coverage from Medi-Cal to Healthy Families in California. This document is intended for Russian speakers.

This Form is used for disability determination services in the state of California. It is used by the Disability Determination Service Division to collect relevant information and assess an individual's eligibility for disability benefits.

This form is used for calculating the property value of qualified disabled working individuals (QDWIs) in California.

This Form is used for reporting potential overpayments related to income or other health coverage in the California Medi-Cal program.

This form is used for reporting potential overpayments related to property total ineligibility or ineligibility for a specific level of services in the Medi-Cal program in California. It is a work sheet designed for reporting and calculating potential overpayments.

This form is used for providing additional information on the facts related to a Medi-Cal child applicant who is under the age of 18 in California. The form is available in Chinese.

This form is used for property owners in California who speak Hmong to provide additional information about their property for government purposes.

This form is used for reporting potential overpayments in Medi-Cal, California's Medicaid program. It is specifically for reporting income or other health coverage that may affect eligibility or payment calculations in the Medi-Cal program.

This form is used for calculating the SGA (Substantial Gainful Activity) work activity of an individual in California. It helps determine eligibility for certain benefits.

This Form is used for determining new beneficiaries for Medi-Cal (Long-Term Care) in the state of California.

This type of document, IRS Form 14815-A, is used to provide supporting documentation to prove eligibility for the Child Tax Credit (CTC) and Credit for Other Dependents (ODC).

This document is for applying for membership to the IRS Security Summit.

This Form is used for changing the name on a standard permit, driver's license, or non-driver ID card in New York.

This form is used for preparing a work sheet related to Section 1931(B) property in the state of California in the case of Sneede V. Kizer.