Loading
Form preview
  • US Legal Forms
  • Form Library
  • Social Forms
  • South Carolina Social Forms
  • Sc Wkr003 2014

Get Sc Wkr003 2014-2026

Date Worker Telephone BG HH Case Name South Carolina Medicaid Program Annual Review Form This form is used to review your Medicaid coverage. You must return this form to us by If you do not return this form your Medicaid will stop* This could affect the amount of your Social Security benefit. Please fill out EACH item on this form* If an item does not apply write does not apply. If an answer to any question is none or 0 write none. If you need help filling out this form call your worker listed above. Si necesita ayuda para llenar este formulario puede llamar a su trabajador cuyo nombre aparece arriba* What language do you use most English Spanish Other specify 1. Fill out the following information about the beneficiary Last Name First Name Middle Initial Mailing Address Include Apartment/Lot Number City County State Zip Code Street Address if different Include Apartment/ Lot Number Telephone Number where we can reach you including area code Phone Second Phone FOR AGENCY USE Date Receiv....

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the SC WKR003 online

Filling out the SC WKR003 form online is an essential step in reviewing your Medicaid coverage. This guide provides detailed, step-by-step instructions to help users successfully complete the form.

Follow the steps to accurately complete the SC WKR003 form online.

  1. Press the ‘Get Form’ button to access the SC WKR003 document and open it in the online editor.
  2. Begin by filling out your personal information in the designated fields. This includes your last name, first name, middle initial, mailing address, city, county, state, and zip code. Ensure that your telephone number is also included.
  3. If an authorized representative is completing the application on your behalf, complete the section for that individual, including their name, phone number, address, and relationship.
  4. List your family members including your spouse and any dependent children. For each, provide their name, social security number, date of birth, and marital status.
  5. Indicate whether your spouse or dependent child works. If yes, fill in their gross pay before taxes and deductions. Remember to provide proof of income for the past four weeks.
  6. Detail any other income received by family members, including child support, alimony, social security income, and any additional sources. Make sure to attach proof of income listed.
  7. Answer questions about any adults in the home who are not currently working, and provide information about past bank account closures and any transfers of cash, property, or resources.
  8. Report on any assets or resources owned by family members, including bank accounts, property, and vehicles. Attach proof of the value of each item listed.
  9. Indicate any changes to private health insurance or long-term coverage and ensure you attach supporting documentation.
  10. Review all provided information for accuracy and completeness. Each item must be filled out; if a section does not apply to you, indicate 'does not apply'.
  11. After completing the form, save your changes and download or print a copy. Ensure you keep a record for your files, and return the completed form by the specified deadline.

Complete your SC WKR003 form online today to ensure continued Medicaid coverage.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Yearly Review Forms | SC DHHS
Which Program are you receiving Medicaid for? Aged, Blind, or Disabled Individuals (ABD)...
Learn more

Related links form

Old Dominion University Application For Virginia In-State Tuition 2019 The University Of Toledo Do Not Resuscitate Orders 2020 University Of California Santa Cruz Sample Tenants Resume 2016 Florida Atlantic University Loan Cancellation Form 2021

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get SC WKR003
Get form
  • 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
  • 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
  • Legal Hub
  • 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
  • Real Estate Handbook
  • All Guides
  • Notarize
  • Incorporation services
  • For Consumers
  • For Small Business
  • For Attorneys
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
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
  • Legal Hub
  • 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
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
© Copyright 1999-2026 airSlate Legal Forms, Inc. 3720 Flowood Dr, Flowood, Mississippi 39232
  • Your Privacy Choices
  • Terms of Service
  • Privacy Notice
  • Content Takedown Policy
  • Bug Bounty Program