Get Mn Dhs-3418-eng 2018-2025

Filling out the MN DHS-3418-ENG form is essential for renewing your health care coverage in Minnesota. This guide will provide clear and supportive instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete your MN DHS-3418-ENG form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by reviewing the Notice of Privacy Practices and Notice of Rights and Responsibilities found in Attachment A. Tear off these pages and keep them for your reference.
3. In Section 1, enter your first name, middle initial, last name, date of birth, social security number, and contact information. Make sure all details are accurate.
4. For Section 2, list others living with you, such as your partner or children under 21, and indicate if they are applying for coverage now.
5. Proceed to Section 3, and indicate if anyone in your household is self-employed. Provide details regarding their type of work, monthly income, and expenses.
6. In Section 4, detail any employment currently held by household members or expected within the next month, including wages and employment duration.
7. Complete Section 5 by listing any additional sources of income received by household members and indicate how often these are received.
8. Answer the questions in Sections 6 through 18 about assets, insurance, and health changes as applicable to your situation. Be thorough and truthful.
9. After ensuring all sections are completed, sign and date the form in the Signature Page section, affirming the accuracy of the information provided.
10. Lastly, gather all necessary proofs, and send copies along with your completed form. Do not send original documents. You can submit your renewal form via fax, mail, or in person to your county or tribal agency.

Complete your MN DHS-3418-ENG form online today!