Form IHS-976 Purchased / Referred Care Proof of Residency

What Is Form IHS-976?

This is a legal form that was released by the U.S. Department of Health and Human Services - Indian Health Service on October 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form IHS-976?
A: Form IHS-976 is a document used to provide proof of residency for Purchased/Referred Care.

Q: What is Purchased/Referred Care?
A: Purchased/Referred Care is a program that provides health care services to eligible American Indian and Alaska Native individuals.

Q: Why do I need proof of residency for Purchased/Referred Care?
A: Proof of residency is required to determine eligibility for the Purchased/Referred Care program.

Q: What documents can be used as proof of residency?
A: Acceptable documents for proof of residency include utility bills, rental agreements, and driver's licenses.

Q: How do I fill out Form IHS-976?
A: You will need to provide your name, address, tribal affiliation, and other relevant information as requested on the form.

Q: What happens after I submit Form IHS-976?
A: After submitting the form, your eligibility for Purchased/Referred Care will be determined based on the provided proof of residency and other eligibility criteria.

Q: Can I appeal if my application for Purchased/Referred Care is denied?
A: Yes, you have the right to appeal if your application for Purchased/Referred Care is denied. Contact your local IHS facility for further instructions on the appeals process.