Follow the steps to complete the application seamlessly.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Enter your applicant information, including your last name, first name, birth date, and AKA (also known as). Specify your gender, ethnicity, language preference, and select your race.
3. Fill in your Social Security Number (SSN) or Alien ID, phone numbers, and email address. Indicate whether it is okay to leave messages.
4. Complete your home address and mailing address if different. Provide the name and contact information of your authorized representative if applicable.
5. In the diagnosis information section, if you are a new applicant, provide details about your HIV-positive diagnosis including the date, risk/exposure category, and any relevant medical history.
6. Attach diagnosis documentation as required for new applicants and indicate which document you are providing.
7. For residency documentation, include two forms of acceptable proof of residency and attach them.
8. Document your income sources and household size by checking the applicable income documents and listing every family member residing in your household.
9. Indicate your health insurance coverage, if applicable, and provide any required supporting documents.
10. Complete all necessary fields, sign where required, and ensure you have included all supporting documents before finalizing the application.
11. Once completed, save your changes, download the form, and print or share it as needed.

Ensure you have all necessary documents ready and complete your application online efficiently.