Loading
Get Md Dhr/fia 9709 2011-2026
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the MD DHR/FIA 9709 online
This guide provides step-by-step instructions for filling out the MD DHR/FIA 9709 form online. It is designed to assist individuals seeking Long-Term Care Medical Assistance and ensures clarity in each section.
Follow the steps to accurately complete the application.
- Click 'Get Form' button to obtain the MD DHR/FIA 9709 form and open it in your preferred online editor.
- Begin by filling out Section A, Benefit Selection. Indicate which benefits you are applying for and if you are receiving any other assistance. Check the corresponding boxes for Long-Term Care Waiver and other benefits.
- In Section B, Applicant Information, provide your personal details including your full name, Social Security number, date of birth, and gender. Ensure accuracy to avoid processing delays.
- Navigate to Section C if you are a non-citizen. Fill out your immigration status information and provide necessary documentation as indicated.
- In Section D, Current Address, provide your home or facility address. If applicable, answer whether you plan to return home soon.
- Complete Section E with your previous addresses for the last five years. This helps confirm your residency history.
- If you have an authorized representative, complete Section F with their information, specifying their relationship to you.
- Section G requires information about your spouse, if applicable. Include their personal details and their financial contribution.
- In Section H, provide details regarding any disabilities, including your Medicare enrollment status if relevant.
- Continue to Sections I through U, providing thorough information requested about veteran status, medical insurance, income, assets, and expenses.
- In Section V, use the additional space for any extra information that did not fit elsewhere in the application.
- Finally, review all information filled out and ensure that it is complete. Save your changes, then proceed to download, print, or share the completed form as needed.
Complete your MD DHR/FIA 9709 application online to ensure timely processing of your Long-Term Care Medical Assistance.
Income for a Maryland health connection includes wages, pensions, and other sources of revenue before taxes. It’s vital to report all forms of income as they impact Medicaid eligibility. By referencing the MD DHR/FIA 9709, you can gain clarity on what counts as income and how to navigate this aspect effectively.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.