Get Dhs Form 3417b

Filling out the Dhs Form 3417b is a crucial step in applying for Minnesota Health Care Programs. This guide provides detailed instructions to assist users in successfully completing the form online, ensuring all pertinent information is accurately submitted.

Follow the steps to complete the Dhs Form 3417b online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In section 1a, choose the Minnesota Health Care Program you wish to apply for by checking the appropriate box. Options include 'All health care programs' or 'MinnesotaCare only'.
3. Fill out your name and address in section 1b. Include your first name, middle initial, last name, date of birth, and both your physical and mailing addresses.
4. Indicate your contact numbers and preferred language in the specified fields. Answer whether you wish to receive a voter registration card and whether you need an interpreter.
5. In section 2, list other individuals living with you, providing their names, relationships to you, and whether they are applying as well.
6. Section 4 requires completion for each individual listed in section 2 who is applying. Include their names, social security numbers, and place of birth.
7. Sections 5 through 10 gather additional household information, such as immigration status, current living situation, and details about dependents, employment, and income.
8. Provide details regarding your household’s finances and assets in sections 11 through 21, indicating income sources and expenditures.
9. Complete section 23 by including any current health insurance information for those applying.
10. Once all sections are filled out, review your answers carefully for accuracy. Save any changes you made.
11. Finally, you can download, print, or share the form as needed, and ensure it is submitted to the appropriate office.

Complete your forms online today to ensure a smooth application process for Minnesota Health Care Programs.