Get Mc 05 Military Verification And Referral Form - Dhcs Ca

The MC 05 Military Verification and Referral Form is a vital document for verifying veterans' benefits and facilitating referrals to County Veterans Service Offices. This guide will provide a clear, step-by-step approach to completing the form online.

Follow the steps to effectively complete the MC 05 form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. In Section A, provide the name and address of the Medi-Cal eligibility worker’s office. This should be the office to which the completed form will be submitted.
3. Enter the name and address of the County Veterans Service Office. This indicates where the form will be forwarded for verification.
4. Input the case worker's contact information, including their name, phone number, and email. This is essential for communication regarding the application.
5. Enter the Medi-Cal case number associated with the applicant or recipient. This information is important for tracking purposes.
6. Fill in the Medi-Cal aid code of the veteran or family member. This code is required to process the form correctly.
7. Provide the veteran's information, including their full name, date of birth, and Social Security number. Ensure accurate data entry, as this information is critical.
8. Document the veteran's marital status by selecting only one option from single, married, divorced, widowed, or unknown.
9. Include the veteran's address details, such as street address, city, state, and ZIP code.
10. If applicable, enter any reported VA income for the veteran to aid in the verification process.
11. Detail the veteran's military background, which may consist of dates of service and branch of the military.
12. If submitting on behalf of a family member, provide their name, relationship to the veteran, date of birth, Social Security number, and address.
13. Add any remarks from the Medi-Cal eligibility worker that may be relevant to the case.
14. Once all sections are filled out, ensure the form is reviewed for accuracy before saving.
15. After verifying all information, save changes to the form. You may also choose to download, print, or share it as needed.

Complete your documents online today to ensure a smooth application process.