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Get SC DHHS 3400-B 2016

-B (June 2016) City County State From (date) To (date) Page 2 of 5 9. If married and entering a nursing home, does the applicant want to give (allocate) part or all of income to a spouse remaining at home? Yes No 10. Does the applicant want to give (allocate) income to dependent adults living in the home or to dependent children? Yes No 11. Does anyone in the applicant s home (including the applicant or applicant s spouse, children or dependent adults) receive or has anyone a.

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