Page 1 of 12 Date received SDS 0539A 05/08 People living with you Use extra paper if needed How many people live with you First Relationship Sex M Are they applying for benefits If yes give types and complete the following Do they intend to stay in Oregon SSN Other important people A. Application Form Instructions Click on a question mark to find out more about verification of certain eligibility requirements. If you would like to apply for benefits please contact your local office Please notify your worker if you need to receive printed information in an alternate format such as Braille large print audio tape or computer disk. See form DHS 1005 Client Information Seniors and People with Disabilities SDS 539A Contact date/Date of request Last name First name MI Address City State Zip code Telephone Mailing address if different Date of birth Social Security Marital status single married divorced widowed separated Citizenship U*S* citizen non-citizen Gender M F Disabled yes no Blind yes ....
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How to use or fill out the OR SDS 0539A online
The OR SDS 0539A form is essential for individuals seeking various services and assistance related to aging and disabilities in Oregon. This guide will provide a clear, step-by-step process to help you successfully complete this form online.
Follow the steps to effectively complete the OR SDS 0539A online.
- Press the ‘Get Form’ button to access the OR SDS 0539A and open it in your preferred editor.
- Begin by filling in the contact date and personal information. This section includes your first name, last name, middle initial, date of birth, and other identification details. Ensure each field is filled accurately to avoid processing delays.
- Provide your current address and any mailing address if it differs from your residential address. Include your city, state, and ZIP code.
- Indicate your marital status and gender. This helps establish your eligibility for specific programs.
- Fill out the income section by providing details of any income sources, such as employment, disability benefits, or support from family. Be thorough in listing all amounts and relevant claim numbers.
- Complete the people living with you section, detailing their names, birthdates, and relations to you. This affects the overall eligibility for services.
- Respond to the questions regarding safety and well-being, particularly if there are any concerns related to domestic threats.
- Indicate if you are applying for specific services, such as medical assistance or food benefits, ensuring to check the boxes that apply.
- Review the housing and medical costs sections, detailing any expenses related to your living situation or health care needs.
- After filling out the form, make sure to review all provided information for accuracy. Save changes, and utilize the download or print options to keep a copy for your records.
Complete your OR SDS 0539A online today to access the assistance you need.
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Oct 1, 2014 - Pend for the SDS 0539A as necessary. Send from the form server SDS 3401...
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