Get Doh 4443

The Doh 4443 form is an essential document for individuals applying for Medicaid in New York. This guide provides clear and supportive instructions for filling out the form online, ensuring that users understand each section and can complete it accurately.

Follow the steps to complete the Doh 4443 online successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated area. Ensure that you print your name clearly.
3. In the financial maintenance section, provide your app. reg/case number, if applicable. This helps to identify your application.
4. List your monthly living expenses in the provided space. Carefully check the box next to each type of expense you have and write the corresponding monthly amount next to it.
5. For each expense listed, provide an explanation of how you pay for it. Include details about cash, income, credit, or any assistance you receive from others, along with their names and relationship to you when necessary.
6. Make sure to calculate your total monthly living expenses and enter this information in the designated box.
7. You will also need to provide your total gross monthly income. Fill in this amount in the appropriate section.
8. In the certification section, read the statement thoroughly. Confirm the accuracy of your information by signing and dating the form.
9. If a facilitated enroller assisted you, they must also sign and date below the applicant/recipient's signature.
10. Review the entire form for completeness and accuracy. Once satisfied, save your changes, and proceed to download or print the form, or share it as needed.

Ready to submit your application? Complete the Doh 4443 online today.