Get Dshs Funding Source - Worksheet Eligibility Items ... - Dshs State Tx

Filling out the DSHS Funding Source - Worksheet Eligibility Items online can seem daunting, but it is essential for determining eligibility for various services in Texas. This guide provides clear and comprehensive steps to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your worksheet eligibility items.

1. Press the ‘Get Form’ button to access the worksheet and open it for editing.
2. Fill in today's date and your client or case number to ensure accurate record-keeping.
3. Enter the applicant's name as it appears in official documents.
4. Indicate the type of determination by selecting either 'New' or 'Re-certification'.
5. Select the relevant case record action by choosing from 'Approved', 'Presumptive', or 'Denied'.
6. Provide the eligibility effective date in the specified format (MM-DD-YYYY).
7. Complete the 'Family Composition - Legal Responsibility' section, listing all members legally responsible.
8. Document residency by noting that applicants must be physically present within Texas’s geographic boundaries.
9. Identify types of income received by each family member and list their names next to the corresponding income type.
10. Provide documentation of residency and income if applicable.
11. Calculate total gross earned income and other income sources, and subtract dependent care to determine net countable income.
12. Check the appropriate percentage of Federal Poverty Level (FPL) that applies: 100%, 150%, 185%, 200%, or 250%.
13. List any other benefits received by the applicant, such as Medicaid or Medicare.
14. Document any special circumstances that may affect this application.
15. Record any co-pay fees in the designated section.
16. Identify the eligible household members by listing their names and selecting corresponding benefits (BCCS, PHC, Title V/MCH, etc.).
17. Sign and date the form at the bottom where indicated by the provider-staff signature line.
18. After reviewing the completed form for accuracy, you can save the changes, download, print, or share as needed.

Start completing your DSHS Funding Source - Worksheet Eligibility Items online today to ensure you receive the services you need.