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Get Social Security Number Attestation Form
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How to fill out the Social Security Number Attestation Form online
Completing the Social Security Number Attestation Form online is a crucial step for applicants seeking Medicaid assistance. This guide will provide you with clear and concise instructions to help you accurately fill out the form.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to retrieve the Social Security Number Attestation Form and open it in your online editing tool.
- Begin by entering your name in the designated field. Ensure the information is accurate and matches official documents.
- Next, provide your address in the appropriate sections, including street address, city, state, and zip code.
- Fill in the current date using the format mm/dd/yyyy.
- Enter your case number, if applicable, in the provided space.
- If you possess a Social Security Number, type it in the specified field. If you do not have an SSN, select one of the following reasons and check the corresponding box: 'I will apply for a Social Security Number,' 'I am in the process of applying for a Social Security Number,' or 'I am not eligible for a Social Security Number due to my immigration status.'
- Complete the attestation section by typing or printing your name clearly and signing the document. This confirms that the information provided is true and correct to the best of your knowledge.
- Finally, save your changes. You can choose to download, print, or share the filled-out form as needed.
Complete your Social Security Number Attestation Form online today.
I _________________________________ certify that I have not been employed, self-employed, completed odd jobs, or had any source of income including gifts or loans during the past 30 days. For the amount of $________________. I received my last payment from this source on or about ___________________________.
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