Get Sc Dhhs 3400-b 2020-2025

The SC DHHS 3400-B form is essential for gathering information regarding eligibility for nursing home, institutional, or in-home care. This guide provides clear instructions on how to complete the form accurately and effectively.

Follow the steps to complete your form with ease.

1. Press the ‘Get Form’ button to access the SC DHHS 3400-B form and open it in the online editor.
2. Begin by entering the name of the person needing assistance, including their first, middle, and last names, followed by their Social Security Number and Medicaid ID.
3. Fill in the date of birth in the format mm/dd/yyyy. If you are completing the form for someone else, include your name as the Authorized Representative and your relationship to the applicant.
4. Answer the questions in the 'Statement of Transfers' section. Indicate 'Yes' or 'No' for each question regarding bank accounts, investments, and property transfers. For any 'Yes' responses, provide additional details including account names and balances.
5. Complete the section pertaining to any motor vehicles, boats, or other recreational vehicles. Again, indicate 'Yes' or 'No' and provide appraised values and sale prices where applicable.
6. In the 'Additional Information' section, check if anyone holds Conservatorship, Guardianship, or Power of Attorney for the applicant, and include relevant details.
7. Provide current location information for the applicant, including whether they are at home, in a hospital, or a nursing home, along with facility details if applicable.
8. Indicate where the applicant has lived over the past five years, including addresses and duration of residence.
9. Respond to questions regarding income allocation to a spouse or dependents, and provide details about any additional income sources if applicable.
10. Notify if the applicant or spouse has any retirement benefits or has received recent inheritances, providing specifics as requested.
11. List any owned properties and assets, their values, and supporting documentation where necessary.
12. Ensure all sections are completed before submitting. You can save changes, print, or share the form as needed.

Complete the SC DHHS 3400-B online today to ensure timely processing of your eligibility application.