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  • Dhhs Form 768

Get Dhhs Form 768

NH Department of Health and Human Services (DHHS) Bureau of Family Assistance (BFA)BFA Form 768 09/19SHARED SHELTER ARRANGEMENTS Client Name: Physical Address: Mailing Address:Case Number: Telephone.

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How to fill out the Dhhs Form 768 online

The Dhhs Form 768 is essential for individuals detailing their shared shelter arrangements and meal arrangements for food stamps. This guide will navigate you through each section of the form to ensure accurate and efficient completion.

Follow the steps to accurately complete the Dhhs Form 768 online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering your name in the 'Client Name' field. Ensure that the name matches your legal identification. Next, fill in your physical address where you currently reside.
  3. In the 'Mailing Address' field, provide the address where you prefer to receive correspondence. If it’s the same as your physical address, you may leave it blank.
  4. Input your case number in the appropriate field. If you do not have a case number yet, consult your local office.
  5. Enter your telephone number to ensure contact regarding your application. Make sure to include the area code.
  6. List everyone living with you in the 'MEAL ARRANGEMENT FOR FOOD STAMPS' section. Fill out the names, their relation to you, and their telephone numbers. Ensure each person’s details are complete.
  7. For each individual listed, answer the questions on whether they are on the shelter's lease and if they buy their own food and eat separately.
  8. Proceed to the 'SHELTER ARRANGEMENT' section. Indicate whether your name is on the lease and provide details about your rent amount and frequency (monthly, bi-weekly, weekly).
  9. Provide responses for your responsibility regarding heating, telephone, and electricity costs. Be truthful in your answers to avoid complications in your application.
  10. If applicable, indicate whether you received fuel assistance in the past 12 months and attach the required documentation if necessary.
  11. Finally, sign and date the form in the client signature section. Ensure that all information is accurate before submitting.
  12. After completing the form, you can save changes, download a copy, print it, or share it as needed.

Complete your Dhhs Form 768 online today for a streamlined application process.

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Contact support

Questions? Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET.

Service authorization requests for Medicaid Fee for Service recipients can be found on the MMIS online portal. All service authorizations should be submitted via secure email at ServiceAuthorizationFFS@dhhs.nh.gov.

Questions? Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET.

Division of Medicaid Services. As Medicaid Director, Henry Lipman is the New Hampshire state lead for coordination with the U.S. Centers for Medicaid and Medicare Services.

Division of Medicaid Services. As Medicaid Director, Henry Lipman is the New Hampshire state lead for coordination with the U.S. Centers for Medicaid and Medicare Services.

Who is eligible for New Hampshire Medicaid? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows

In New Hampshire, there are three Medicaid Health Plans to choose from: AmeriHealth Caritas New Hampshire. NH Healthy Families. WellSense Health Plan.

Anyone who suspects any acts of abuse, neglect, exploitation and/or other service rights violations are encouraged to call the toll free number (1-855-450-3593)

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232