Get 2011 Fhiap Application Form

The 2011 Family Health Insurance Assistance Program (FHIAP) Application Form allows users to apply for health insurance assistance. This guide will walk you through the steps required to complete the form online accurately and efficiently.

Follow the steps to successfully complete the FHIAP application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor where you can start filling it out.
2. Begin with Section A: Applicant Information. Fill out your name, county, home or street address, city, state, and ZIP code. If applicable, include a mailing address. Ensure you provide your home phone number, another phone number, and email address if available.
3. Indicate your current marital status by selecting the appropriate option: single, married, divorced/legally separated, widowed, or separated. If applicable, fill in your spouse's information.
4. Provide your employment status details. Choose from full-time, part-time, unemployed, retired, or self-employed. You will also need to include your Employer ID number, employer’s name and contact information, and their mailing address.
5. Section B requires family information. List each person in your household, providing their names, dates of birth, Social Security numbers, citizenship status, and any healthcare insurance information. Indicate if any family members are pregnant.
6. In Section C, report your income. Indicate if you or your spouse is self-employed, detailing your monthly income sources. Include proof of income for the past two months.
7. Complete Section D by listing your investments and savings. Include details on any properties owned, their value, and whether they are rented.
8. Review the legal statements in Section E. By signing, you attest that the information provided is accurate and complete. Both the applicant and spouse must sign, even if not both are applying for assistance.
9. After all sections are completed, save your changes. You will then have the option to download, print, or share the completed application.

Begin filling out the 2011 FHIAP application form online today for your health insurance assistance.