Get In Sf 55390 2013-2025

This guide provides step-by-step instructions for filling out the Indiana Application for Health Coverage (State Form 55390) online. By following these clear directions, you can ensure that your application is completed accurately and efficiently.

Follow the steps to complete your application online.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin with Section 1 by providing your name and contact information if you are completing the application for someone else. If applicable, fill out the information for the person needing assistance in Section 2, including their checkboxes for health coverage.
3. Complete Section 3 by entering the home address, telephone number, and indicating how many people live at the address.
4. Section 4 requires you to provide a mailing address if it differs from the home address.
5. In Section 5, ensure you sign and date the application, certifying that all the provided information is true to the best of your knowledge.
6. Section 6 addresses ethnicity and race. Indicate your responses to the questions about Hispanic or Latino ethnicity and select your race.
7. Next, in Section 7, confirm your citizenship or immigration status. This includes answering questions about the type of documentation you hold.
8. Section 8 inquiries about your living situation, such as if you are pregnant or have dependents. Provide accurate responses to help determine your eligibility.
9. In Section 9, answer the tax filing questions accurately, specifying if you plan to file a federal income tax return next year.
10. Fill in Sections 10 to 12 regarding your current employment and other sources of income, checking applicable boxes and providing amounts where required.
11. For Sections 13 to 15, list any deductions and your expected annual income, as well as any resources you may have.
12. Complete Sections 16 to 19 to provide information about your health coverage status and contact details.
13. If there are additional individuals listed in your household or on your tax return, complete Section 20 with their details as necessary.
14. Continue through the remaining sections regarding citizenship, health coverage from jobs, and your representative's information if you are applying on someone else's behalf.
15. Finally, review the complete form for accuracy, then save your changes, download, print, or share the application as needed.

Start completing your application online to secure your health coverage.