Get Peehip Poverty Form

This guide provides clear instructions on how to complete the Peehip Poverty Form online. By following these steps, users can easily navigate through each section to ensure accurate submission for Federal Poverty Level premium assistance.

Follow the steps to successfully fill out the Peehip Poverty Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your subscriber information as required. This includes your first name, middle name or initial, last name, social security number or PID number, and mailing address. Be sure to write your name exactly as it appears on your Social Security card.
3. Provide your contact details by filling in your home and work phone numbers, along with your city, state, and ZIP code.
4. Indicate your marital status by selecting the appropriate option: single, married, divorced, legally separated, or widowed.
5. Attach a signed copy of your prior year's Federal Income Tax Return Form 1040, 1040A, or 1040EZ along with any supporting documents such as 1099s and W-2s. If applicable, also include your spouse's tax return if you did not file jointly.
6. Complete the PEEHIP subscriber certification by declaring that all provided information is true, complete, and accurate. Sign and date the application in the provided fields.
7. Mail the completed form to the address indicated at the top of the form. Ensure all attachments are included for your application to be processed.
8. After submitting, remember that you must reapply for assistance every year during Open Enrollment and that this application only allows one submission per plan year.

Begin completing your Peehip Poverty Form online today to secure your premium assistance.