Get Application For Participation In The Elder Dental ... - Community Vna

The Application For Participation In The Elder Dental Program is designed to assess your eligibility for access to dental services at reduced fees based on your income. This guide provides step-by-step instructions on how to fill out the application online, ensuring a seamless process.

Follow the steps to complete your application successfully.

1. Press the ‘Get Form’ button to obtain the application form and open it in your preferred online editor.
2. Fill in your personal information in the 'Applicant Information' section. This includes your name, phone number, street address, town, state, zip code, and date of birth. Additionally, indicate your gender and marital status.
3. Provide information about how you learned about the Elder Dental Program and respond to questions regarding your participation in MassHealth and current dental care.
4. Complete the 'Oral Health Questions' section. Answer yes or no to each question and provide further details as required.
5. In the 'Financial Information' section, indicate your yearly income from various sources, including Social Security, jobs, and any other income. Ensure to include your spouse’s income if married.
6. List your resources that could be converted into cash, including checking and savings accounts, stocks, and other valuables.
7. Carefully read the guidelines for income documentation, ensuring that you prepare photocopies of your financial documents and do not send original documents.
8. Review and understand the 'Assignment of Rights' section, which outlines your rights and responsibilities as a participant in the program. Sign and date the application.
9. Once you have completed the application, save your changes, and then either download, print, or share the form as needed.

Complete your application online today to access the benefits of the Elder Dental Program.