Get Indiana State Form 55390 R7 8 17

This guide provides detailed instructions on how to fill out the Indiana State Form 55390 R7 8 17 online. The form is designed for individuals applying for health coverage and includes various sections that require precise information to ensure accurate processing of your application.

Follow the steps to complete your application accurately.

1. Click the ‘Get Form’ button to obtain the application form. This will open the form in your on-screen editor.
2. In Section 1, if you are completing the application on behalf of someone else, provide your name and contact information if you do not live in their household. If you do live with them, enter your information in Section 21.
3. In Section 2, provide the information for the person needing assistance and check the applicable box regarding health coverage.
4. Continue to Section 3 to fill in the home address details. If the mailing address is different, complete Section 4.
5. Proceed to Section 5 and ensure you sign the application. Remember that the signature is crucial for the submission.
6. In Section 6, complete the optional ethnicity and race information. This data is not mandatory but can be helpful.
7. Fill out Section 7 regarding citizenship or immigration status. If not applying, you may skip this section.
8. Continue through Sections 8 to 30, providing detailed employment, income, and health coverage information as required.
9. In Section 31, answer questions about tobacco usage, which is relevant for certain health plans.
10. Complete Section 32 if anyone in the household is offered health coverage from a job.
11. After filling out all relevant sections and reviewing your information for accuracy, save your changes, then download, print, or share the form as needed.

Ensure your application for health coverage is complete by following these steps online.