Get F 10101

Filling out the F 10101 form online is an essential step for applying for health care benefits through Wisconsin Medicaid. This guide provides a clear and structured approach to help you complete the form accurately.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Read the 'Important Information' section carefully. This section contains crucial guidelines that ensure your understanding of the application process.
3. Print clearly using blue or black ink if filling out a hard copy, or type all required fields clearly if online.
4. Provide your date of birth and place of birth in the specified format (MM/DD/YYYY) under the 'Applicant Information' section.
5. Fill out your contact information. Include various phone numbers and specify the best way to reach you during weekdays.
6. Complete the 'Additional Applicant Information' section, including your current address and marital status.
7. If applicable, include information about your spouse, detailing their name, date of birth, and whether they are applying for Medicaid.
8. Complete the 'Disability Information' section, identifying whether you or your spouse have been determined blind or disabled.
9. List all assets owned by you and/or your spouse in the 'Assets' section. Provide as much detail as possible, and replace any blank spaces with 'N/A' as needed.
10. In the 'Income' sections, report job income, self-employment income, and any other sources of income, ensuring to include gross amounts.
11. Review all completed sections for accuracy and completeness. Refer to the checklist provided near the end of the form.
12. Sign and date the application at the 'Signature' section. Ensure that witnesses sign if required.
13. Submit your application by mailing or faxing it to the appropriate address listed for your area, or uploading any required proof online.

Start your application process for the F 10101 online today and ensure your eligibility for health care benefits.