Get Im-80a (revision 08-01) - Missouri Department Of Social Services - Dss Mo

Filling out the IM-80a form is an essential step for individuals whose eligibility for social services has changed. This guide provides a clear and concise walkthrough to help users complete the form accurately and effectively online.

Follow the steps to fill out the IM-80a form correctly

1. Click ‘Get Form’ button to obtain the form and launch it in your preferred method.
2. Begin by entering the date at the top of the form. This should reflect the current date you are completing the form.
3. Fill out your address in the designated sections. Ensure that your information is accurate and up-to-date.
4. Record your name in the ‘Claimant Name’ field. This should be the individual whose eligibility is changing.
5. Indicate your county of residence by selecting the appropriate option from the dropdown menu.
6. Enter your case number in the specific field provided. This number is vital for processing your request.
7. In the next section, explain how your eligibility has changed. Be clear and concise in your explanation.
8. Provide details of the benefit changes, including the new cash benefit amount and any other relevant notes.
9. Specify the month that the change will take effect. This should align with when you expect to receive the notice.
10. Detail the dates your MC+/Medicaid coverage will end, filling in the month, day, and year as required.
11. List the individuals affected by this change in coverage, ensuring to include all relevant persons.
12. Sign and date the form at the bottom, confirming that you understand the implications of the changes being made.
13. If applicable, ensure the statement of the caseworker is completed by the caseworker, including their signature and title.
14. Once all sections are complete, you can save your changes, download the form for your records, print it for submission, or share it as needed.

Complete and submit your IM-80a form online to ensure a seamless transition in your benefits.