Get Ca Cdph 8727 2018-2026

The CA CDPH 8727 form is essential for individuals who are homeless or do not have proof of residency in California. This guide provides clear and supportive instructions on how to fill out the form online, ensuring users can complete it accurately and efficiently.

Follow the steps to complete the CA CDPH 8727 online.

1. Click the ‘Get Form’ button to access the CA CDPH 8727 and open it in the online editor.
2. In Section 1, provide your applicant information by entering your full name (first, middle initial, last) and your date of birth. Also, include your Client ID number if applicable.
3. Proceed to Section 2, where the enrollment worker, provider, or agency will attest to the applicant's residency status. Select one of the provided certification options that best describes the relationship with the applicant, and if applicable, enter the client’s verified residential address including city, state, and zip code.
4. In Section 2, note that the address verification is valid for one year from the submission date unless otherwise specified.
5. For Section 3, the enrollment worker, provider, or agency representative must complete their information, certify the accuracy of the provided information by signing and dating the form, and include their agency address.
6. Enrollment workers must also initial the statement regarding the accuracy of information to acknowledge understanding of the implications of providing false information.
7. The applicant then needs to sign Section 3 to certify that the information provided is factual and agree to notify the CDPH of any changes in residency. This includes signing and dating the form.
8. Once all sections are completed, you can save your changes, download, print, or share the form as needed.

Complete your CA CDPH 8727 online today for a smoother process.