Get Pa Form Pa 1572 2009
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How to fill out the PA Form PA 1572 online
This guide provides a clear and helpful framework for users looking to complete the PA Form PA 1572 online. Designed for couples where one partner resides in a nursing facility or has been assessed for Home and Community Based Services, this form helps assess and protect a couple's financial resources.
Follow the steps to complete the PA Form PA 1572 online effectively.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your personal information in the designated fields, including last name, first name, middle initial, address, date of birth, and social security number. Also, enter the date of admission to the nursing facility or the date of assessment for Home and Community Based Services.
- Next, include the information for your spouse by filling out their last name, first name, middle initial, date of birth, address, social security number, and telephone number in the provided sections.
- Proceed to the resources section. Here, you will list all resources owned individually or jointly, including cash, bank accounts, stocks, and any other assets. Make sure to indicate the total value and the amount owed for each resource.
- Attach photocopies of the verification documents for each resource listed. Avoid sending original documents, as they will not be returned.
- Complete the life insurance section for each policy, providing the name of the insured, insurance company, policy number, face value, cash value, and date acquired.
- Fill out the legal representation section if applicable, providing the name and contact information of a legal representative other than the spouse.
- Review the checklist to ensure all required information has been completed, including signatures and attachments.
- Finally, save your changes, and proceed to download, print, or share your completed form as needed.
Complete your documents online to ensure a smooth assessment process.
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