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B. 4 Remarks ADDITIONAL INFORMATION. Associate with application previously submitted on PRIOR ACTION Denial Review Termination Ongoing Original date of application Pursuant to Provisions of North Carolina Disability/Incapacity Regulations It is determined that the applicant is Diagnosis Under a disability since DIARY/RE-EXAM Primary Not under a disability Type Continuing disabled Mo/Yr Not continuing disabled Code No Reason Incapacitated Other Not incapacitated Reg. Basis Code Med List No. Vocational Background Occ Yrs. Ed Yrs. VR Referral Previously Referred Recommended RATIONALE See Attached Date Case Released Disability Examiner Date DMA-4037 Rev. 08/06 Medical Examiner. DISABILITY DETERMINATION TRANSMITTAL Mail to DISABILITY DETERMINATION SERVICES PO Box 243 Raleigh NC 27602 Received in DDS Aid Program/Category County No County Case No Application No Worker Dist. No Application Date Attn Medicaid Unit 09 42 or 44 Name and Address of Applicant Worker Phone Date Submitted Social Secu....

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How to fill out the Dma 4037 online

Filling out the Dma 4037, or Disability Determination Transmittal, can be a straightforward process if approached step by step. This guide provides clear instructions to help users complete the form accurately and efficiently.

Follow the steps to complete your Dma 4037 online.

  1. Press the ‘Get Form’ button to access the Dma 4037 and open the document in your preferred editing tool.
  2. Enter the 'Applicant Name and Address' section with the full name and current address of the individual applying for benefits.
  3. In the 'Aid Program/Category' field, specify the relevant program or category by selecting the appropriate option.
  4. Fill in the 'County' and 'County Case Number' information. This helps in identifying the local office managing the case.
  5. Provide the application date and the application number for reference. This information is crucial for tracking the application.
  6. Complete the 'Social Security Number' and 'Date of Birth' fields of the applicant. Accuracy is important.
  7. Indicate the applicant’s sex in the designated field to ensure complete demographic information.
  8. If applicable, denote 'Retroactive Coverage Needed' by marking the relevant option.
  9. Check the boxes for the appropriate aids (e.g., 'MAO' or 'SA' forms) that are referenced in the document.
  10. Fill in the 'Diagnosis' and the date when the disability started, ensuring that this aligns with medical documentation.
  11. Complete the diary/re-exam section as necessary, indicating if the applicant is under a disability or not, along with relevant codes and reasons.
  12. Review any additional comments and observations that may apply to the applicant’s case.
  13. After all fields have been completed, you may save changes, download the document, or print it for submission.

Complete your Dma 4037 online today to ensure a smooth application process.

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The NCFAST-20020 is a prepopulated renewal form for the beneficiary to validate that current information remains the same or indicate changes and provide self-attestation of eligibility requirements, including income.

Effective January 1, 1995, SSI beneficiaries in North Carolina automatically receive Medicaid. This is the section of the North Carolina Department of Health and Human Services (DHHS) which is responsible for making determinations of disability for RSDI, SSI, and Medicaid. This is the date that the disability began.

In approximately half of the states, ABD Medicaid's income limit is $914 / month for a single applicant and $1,371 for a couple. In the remaining states, the income limit is generally $1,215 / month for a single applicant and $1,643 / month for a couple.

In the State of North Carolina, those categories include: Age 65 or older. Blind or disabled. Infants and children under the age of 21. Low-income individuals and families. In need of long-term care. Receiving Medicare.

To be eligible for North Carolina Medicaid, you must be a resident of the state of North Carolina, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

Income & Asset Limits for Eligibility April 2023 – March 2024 North Carolina Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Regular Medicaid / Aged Blind and Disabled$1,215 / month$1,644 / month3 more rows • Mar 15, 2023

NC Medicaid Managed Care Health Plans. Behavioral Health I/DD Tailored Plans. EBCI Tribal Option. Health Plan Contracts.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232