Get Hdap Application

This guide provides a comprehensive walkthrough to assist users in filling out the Hdap Application online. By following these steps, applicants can ensure that they provide all necessary information accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the application and open it for editing.
2. Begin with Section 1, which focuses on applicant information. Fill in your first name, middle initial, and last name. If you are a minor, include the name of your legal guardian.
3. Complete the date of birth field using the MM/DD/YYYY format. Provide your social security number next.
4. Enter your residential street address, including city, county, state, and ZIP code. If your mailing address differs from your residential address, fill in the appropriate fields.
5. Provide your phone numbers and indicate whether you consent to messages being left on your voicemail or answering machine.
6. In the gender section, choose the correct option and complete any additional questions regarding pregnancy status or transgender status if applicable.
7. Continue to Section 2 for income information. Indicate your current annual income and specify your sources of income.
8. Confirm whether you filed an income tax return for the last year, and indicate your employment status and health insurance offerings from your employer.
9. Proceed to Section 3, which requires provider information. Ensure your case manager and clinician complete the necessary details about your medical care.
10. In Section 4, provide pharmacy information including the name and address of your pharmacy.
11. Section 5 covers insurance coverage. List any current health insurance or prescription coverage you hold, and attach the required documentation.
12. For Section 6, if applicable, indicate whether you had health insurance coverage within the last 60 days and specify the insurance type you wish the CHII program to cover.
13. In Section 7, you may designate an alternate contact for communication with HDAP if necessary.
14. Finally, complete Section 8 by signing the certification statement to affirm the accuracy of your information.
15. After thoroughly reviewing your application for completeness, save changes, and consider downloading, printing, or sharing the completed form as needed.

Complete your Hdap Application online today to ensure you receive the support you need.