Get Dma 5150

The DMA 5150 is a crucial form used to document the eligibility or ineligibility for disregarding some or all Social Security income under MA-2110. Completing this form accurately is essential for maintaining a permanent case record when an applicant or recipient has Social Security income and exceeds income limits.

Follow the steps to fill out the DMA 5150 effectively.

1. Click the ‘Get Form’ button to access the DMA 5150 and open it in the online editor.
2. Fill in the 'Date completed' field with the appropriate date when you are completing the form.
3. In the 'Completed by' section, provide your name or the name of the individual completing the form.
4. Answer the question regarding whether the applicant or recipient (a/r) ever received Supplemental Security Income (SSI) by selecting either 'Yes' or 'No.' If 'Yes,' indicate the termination date.
5. If the a/r is currently living in assisted living, indicate whether they ever received Special Assistance with a 'Yes,' 'No,' or 'N/A' option. If 'Yes,' provide the termination date in the designated field.
6. For the 'COLA Passalong' section, mark 'Eligible' or 'Ineligible' based on the evaluation. Provide a reason for this assessment in the space provided.
7. In the 'DAC Passalong' section, again select 'Eligible' or 'Ineligible' and explain the reason for your choice in the designated area.
8. Complete the 'Widow(er)s Passalongs' section by marking 'Eligible' or 'Ineligible' and providing an explanation in the reason space.
9. Document the sources of information checked and obtained, including any statements from the a/r, SDX, EIS, calls to SSA, or any other relevant information.
10. Once all fields are completed accurately, proceed to save your changes, download, print, or share the completed DMA 5150 form.

Complete your documents online for efficient and accurate processing.