Reset Form Ohio Department of Medicaid RESOURCE ASSESSMENT WORKSHEET Assistance Group Number Street Address Institutional Spouses Name City, State and Zip Community Spouses Name County Mailing Date.

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How to fill out the ODM04076 - Resource Assessment Worksheet online

The ODM04076 - Resource Assessment Worksheet is an important document used by the Ohio Department of Medicaid. This guide provides clear, step-by-step instructions for completing the worksheet online, ensuring that you accurately provide the necessary information regarding your resources.

Follow the steps to effectively fill out the ODM04076 - Resource Assessment Worksheet online.

  1. Click the ‘Get Form’ button to access the worksheet and open it in your chosen editor.
  2. Begin by entering the assistance group number at the top of the form. This number is essential for identifying your case.
  3. Fill in the street address, city, state, and zip code for both the institutional and community spouse. Ensure that this information is accurate and complete.
  4. List the name of the institutional spouse and the community spouse in the relevant sections provided.
  5. Indicate the mailing date of the form on the specified line.
  6. In the section for resources, list each type of resource owned by the couple in the appropriate fields, along with the method of documentation and the value as of the first period of institutionalization. Ensure that the values are current and accurate.
  7. Continuing from the resources section, make sure to fill out all categories, including cash on hand, savings accounts, real property, and any additional resources, providing values for each.
  8. Once all fields are completed, review the total value of resources at the bottom of the worksheet to ensure it is calculated correctly.
  9. Finally, sign the document where indicated and provide the caseworker's district ID and telephone number.
  10. After verifying all information, save your changes, and you may also choose to download, print, or share the completed form.

Start completing the ODM04076 - Resource Assessment Worksheet online today for a smooth documentation process.

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