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Form DOH-5247IT Medicaid Authorized Representative Designation / Change Request - New York (Italian)
This is a legal form that was released by the New York State Department of Health - a government authority operating within New York.
The document is provided in Italian. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DOH-5247IT?A: Form DOH-5247IT is a Medicaid Authorized Representative Designation/Change Request form.
Q: Who is this form for?A: This form is for residents of New York who need to designate or change their Medicaid Authorized Representative.
Q: What is the purpose of this form?A: The form is used to designate or change a person who can act on behalf of a Medicaid recipient.
Q: Do I need to fill out this form if I already have an authorized representative?A: No, you only need to fill out this form if you need to designate a new representative or change your existing representative.
Q: Are there any specific language requirements for this form?A: Yes, Form DOH-5247IT is available in Italian.
Q: Is there a deadline for submitting this form?A: There is no specific deadline mentioned. However, it is recommended to submit the form as soon as possible.
Q: Is there any fee associated with this form?A: There is no information provided about any fee associated with this form.
Form Details:
- Released on November 1, 2017;
- The latest edition provided by the New York State Department of Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a fillable version of Form DOH-5247IT by clicking the link below or browse more documents and templates provided by the New York State Department of Health.
