Get Ky Medicaid Change Of Address Form

Filling out the Ky Medicaid Change Of Address Form online is a straightforward process that helps ensure your Medicaid information remains current. This guide provides clear, step-by-step instructions to assist you in completing the form efficiently and accurately.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to access the Medicaid Change Of Address Form and open it for editing.
2. In the first section, enter the today’s date. This helps to establish when the address change is being reported.
3. Provide your name in the field for the person reporting the address change. This is essential for keeping track of the information.
4. Fill in the phone number of the person reporting the change. Ensure that this number is accurate so that any necessary follow-up can occur.
5. Enter the case name, including first, middle, last name, and any suffix. This identifies your specific Medicaid case.
6. Input your Medicaid case number or Social Security number in the designated area for proper identification.
7. In the section labeled 'When did your mailing address change,' indicate the effective date of your change of address.
8. Fill in your new mailing address, making sure to include the street address, apartment number (if applicable), city, state, and zip code.
9. If your home address is different from your mailing address, complete the next section with the same details: street, apartment number (if applicable), city, state, and zip code.
10. Review the certification statement regarding the truthfulness of the information provided. Ensure you understand the implications of providing false information.
11. Provide your signature in the designated area, affirming that all information is accurate and complete.
12. Date your signature in the provided space.
13. Once all sections of the form are complete, you can save changes, download, or print the form for your records. Be sure to submit it as directed, either via fax or mail.

Start completing your Ky Medicaid Change Of Address Form online today to keep your information updated.