Get Dhs 0777

The Dhs 0777 form is a key document used to apply for long-term services and supports through the Arkansas Department of Human Services. This guide will help users understand each section of the form and provide step-by-step instructions for filling it out online.

Follow the steps to complete the Dhs 0777 online process:

1. Press the ‘Get Form’ button to obtain the Dhs 0777 form and open it in your online editor.
2. Begin by indicating the services you are requesting at the top of the form. You can select options such as Nursing Facility, ALF, ARChoices, PACE, or DDS Waiver, based on your needs.
3. In the 'Information About You' section, respond to all questions. You will provide your full name, current address, age, and whether you are a resident of Arkansas.
4. If applicable, fill in details about your spouse in the 'Information About Your Spouse' section, which includes their name, address, and other relevant information.
5. Proceed to the 'Income' section where you will check the sources of income for you and your spouse. List the amounts received and how often you receive them.
6. In the 'Resources – Real Property' section, indicate any homes or other properties owned or being purchased, and provide equity values for each.
7. Fill out the 'Resources – Personal Property' section to list your personal assets, including cash, bank accounts, vehicles, and any livestock or other resources you may own.
8. Complete the 'Insurance' section, detailing any health or long-term care insurance you may have.
9. Address the 'Unpaid Medical Expenses' section by indicating if you have any unresolved expenses from the past three months.
10. Review the 'Rights and Responsibilities' section, ensuring you understand the terms and conditions before signing the form.
11. Finally, save your completed form. You may have options to download, print, or share the form electronically to finalize your submission.

Complete your Dhs 0777 application online to ensure timely processing.