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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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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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