Form DHCS6065B Good Cause Certification - California

Form DHCS6065B Good Cause Certification - California

What Is Form DHCS6065B?

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. Check the official instructions before completing and submitting the form.

FAQ

Q: What is Form DHCS6065B?
A: Form DHCS6065B is a Good Cause Certification form used in California.

Q: What is the purpose of Form DHCS6065B?
A: The purpose of Form DHCS6065B is to certify that an individual has a good cause for not meeting certain requirements for Medi-Cal eligibility.

Q: Who needs to fill out Form DHCS6065B?
A: Form DHCS6065B needs to be filled out by individuals applying for Medi-Cal who have a good cause for not meeting the eligibility requirements.

Q: What information is required on Form DHCS6065B?
A: Form DHCS6065B requires personal information of the applicant, details of the good cause, and supporting documentation if available.

Q: How should Form DHCS6065B be submitted?
A: Form DHCS6065B should be submitted to the local county Medi-Cal office.

Q: Can I request assistance in filling out Form DHCS6065B?
A: Yes, assistance can be requested from the county Medi-Cal office or other authorized individuals/agencies.

Q: Is there a deadline for submitting Form DHCS6065B?
A: The deadline for submitting Form DHCS6065B is usually within a specified time frame after the initial Medi-Cal application.

Q: What happens after submitting Form DHCS6065B?
A: After submitting Form DHCS6065B, the county Medi-Cal office will review the application and the good cause certification to determine eligibility.

Q: What if my Form DHCS6065B is denied?
A: If Form DHCS6065B is denied, the applicant has the right to request a hearing to appeal the decision.

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Form Details:

  • Released on February 1, 2015;
  • The latest edition provided by the California Department of Health Care Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DHCS6065B by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.

Download Form DHCS6065B Good Cause Certification - California

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  • Form DHCS6065B Good Cause Certification - California, Page 1
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