Get F 13039 And Wisconsin Department Of Health Services Form
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How to fill out the F 13039 And Wisconsin Department Of Health Services Form online
The F 13039 form, also known as the Wisconsin Department of Health Services form, is essential for those applying for the estate recovery program. This guide provides clear, step-by-step instructions on how to complete the form online to ensure that you provide all necessary information accurately and efficiently.
Follow the steps to fill out the F 13039 form online.
- Click ‘Get Form’ button to access the form and open it in your preferred editing tool.
- In Section I, enter the date you completed the form, along with the agency name, your worker's name, and their telephone number.
- Proceed to Section II, where you will fill in your information as the applicant, including your name (last, first, middle initial), address (street, city, state, zip code), date of birth, and social security number.
- If applicable, answer the question regarding whether your spouse is also applying. If yes, provide their name, address, birthdate, and social security number in the designated fields.
- In Section IV, provide information about any dependent children who are blind, disabled, or under the age of 21. Enter their names, birthdates, addresses, and a brief explanation of any disabilities.
- Section V requires you to list all assets. Indicate the dollar value for the applicant, spouse, and any joint ownerships for various types of properties and accounts. Make sure to attach tax bills for real estate.
- In Section VI, provide information for the guardian or power of attorney, if applicable, including their name, telephone number, and address.
- Finally, in Section VII, affix your signature, indicate the date signed, and answer whether you agreed to sign the form. Include any comments if necessary.
- After completing all sections, review the form for accuracy, then save your changes, download, print, or share the completed form as needed.
Complete your F 13039 and Wisconsin Department of Health Services Form online today for a smooth application process.
Filling out an authorization for release of health information begins with obtaining the F 13039 and Wisconsin Department Of Health Services Form. Fill in your personal details and those of the recipient, along with specifics regarding the health information to be shared. Clearly define the purpose for the release and the time frame for which the authorization is valid. Using uslegalforms will streamline this process and ensure you meet all necessary requirements.
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