Follow the steps to complete the LA BHSF 1-MB form online successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the Personal Information section. Fill in your first name, middle initial, last name, suffix, social security number, marital status, date of birth, and gender.
3. Next, indicate whether you identify as Hispanic or Latino, and select your race from the options provided.
4. In the Contact Information section, include your mailing address and home address if they differ. Make sure to list your home parish, home phone, cell phone, and any other contact methods.
5. If you are married and living with a spouse, complete the Spouse’s Information section, providing their name, social security number, date of birth, and race, as well as answering if they wish to apply for the Medicare Savings Program.
6. Proceed to the Medicare Information section. Enter your Medicare claim number and indicate whether you or your spouse have additional health insurance.
7. In the Money from Jobs section, provide details about anyone in the household who is employed, including their name, employer information, and income.
8. Then, in the Other Money section, record any other income sources, detailing who receives the money and the amount.
9. If applicable, you can document any medical expenses incurred in the past three months in the Medical Expenses section.
10. Complete the Things You Own section, indicating any assets and their estimated values.
11. Before finalizing the application, read through the Rights and Responsibilities section to understand your obligations and rights.
12. Finish by signing the application to attest to the truthfulness of the information provided. If applicable, have your spouse sign as well.
13. Finally, save any changes made to the form, download it, print it, or share it according to your needs.

Start filling out your application online today to secure your Medicare savings.