Get Statement Of Claimant Or Other Person

The Statement of Claimant or Other Person is a vital document for individuals seeking Medicaid benefits from the Alabama Medicaid Agency. This guide will provide clear and step-by-step instructions to help users complete this form online with ease.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the Statement of Claimant or Other Person. This action will allow you to access the form in the online editor.
2. Begin by entering the name of the claimant in the designated field. Ensure that the name is spelled correctly to avoid any processing issues.
3. Input the social security number of the claimant in the next field. Double-check for accuracy, as this information is crucial for identifying the claimant.
4. If someone other than the claimant is making the statement, provide their name in the appropriate section along with their relationship to the claimant.
5. In the large text area provided, write a clear statement certifying the right to payment of Medicaid benefits. This section should articulate the claim's basis and any pertinent information supporting the claim.
6. Ensure that all information entered is complete and accurate. This document requires honesty, as false claims may result in legal penalties.
7. Proceed to sign the form by entering your name as the person making the statement. Include today's date and your contact telephone number.
8. Finally, if the statement was signed using a mark, remember that two witnesses must sign in the designated space along with their addresses.
9. Once you have reviewed and confirmed all entries, save the changes. You can then download, print, or share the completed form as needed.

Complete your Statement of Claimant or Other Person online today for efficient processing.