Form DE-101 (DE-202) Request for Application for Arizona Long Term Care System (Altcs) - Arizona

Form DE-101 (DE-202) Request for Application for Arizona Long Term Care System (Altcs) - Arizona

What Is Form DE-101 (DE-202)?

This is a legal form that was released by the Arizona Health Care Cost Containment System - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DE-101 (DE-202)?
A: DE-101 (DE-202) is the form used to request an application for the Arizona Long Term Care System (ALTCS).

Q: What is ALTCS?
A: ALTCS stands for Arizona Long Term Care System. It is a program that provides healthcare and long-term care services to eligible Arizona residents who are elderly, disabled, or have chronic illnesses.

Q: What do I need to include in the DE-101 (DE-202) form?
A: The DE-101 (DE-202) form requires you to provide personal information, such as your name, address, and contact details. You will also need to provide information about your medical condition and financial situation.

Q: Are there any fees for submitting the DE-101 (DE-202) form?
A: No, there are no fees for submitting the DE-101 (DE-202) form.

Q: What happens after I submit the DE-101 (DE-202) form?
A: After you submit the DE-101 (DE-202) form, ALTCS will review your application and determine your eligibility for their program. They may contact you for additional information or schedule an in-person assessment.

Q: How long does it take to get a decision on my ALTCS application?
A: The processing time for ALTCS applications can vary, but you can expect to receive a decision within 45 days of submitting your DE-101 (DE-202) form.

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Form Details:

  • Released on April 1, 2023;
  • The latest edition provided by the Arizona Health Care Cost Containment System;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DE-101 (DE-202) by clicking the link below or browse more documents and templates provided by the Arizona Health Care Cost Containment System.

Download Form DE-101 (DE-202) Request for Application for Arizona Long Term Care System (Altcs) - Arizona

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