Get Dhs-5576-eng (combined Six-month Report). This Form Is Sent To Clients Who Have A Six-month Renewal

Filling out the DHS-5576-ENG (Combined Six-Month Report) is an essential step for clients undergoing a six-month renewal. This guide will walk you through the process, ensuring all necessary information is provided accurately.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering your full name and address. Make sure all names and addresses are spelled correctly, and include your date of birth and phone number.
3. Indicate if anyone has moved in or out of your home in the past six months. If applicable, fill in the details regarding their names and dates of change.
4. Answer whether anyone in your household is receiving health care coverage through Medical Assistance (MA). Depending on your answer, proceed to the relevant questions.
5. If anyone in your household is self-employed, provide their details such as business name, start date, and annual income.
6. If anyone is currently employed or expects to be, enter their employment information including employer name, start date, and income details.
7. Describe any other income sources you or your household members may have. Be sure to document details and attach any required proofs.
8. For those aged 21 or older, indicate if they are enrolled or applying for Medical Assistance (MA) or a Medicare Savings Program.
9. Report on any cash or bank accounts, and provide proof of current balances if applicable.
10. Document any assets such as stocks or bonds, and include proof of their current value.
11. If applicable, provide information regarding any vehicles owned.
12. Detail any real estate properties owned by you or your household members.
13. Report any changes related to court-ordered payments or other significant financial changes since the last application.
14. Indicate whether your household receives Supplemental Nutrition Assistance Program (SNAP) benefits. If so, answer subsequent questions regarding any changes to your household.
15. Finally, ensure that all sections are completed and sign the form. Make sure you understand the information about the implications of your answers.
16. Once completed, save your changes, download the form, or print it out for submission.

Submit your completed DHS-5576-ENG form online to ensure timely processing of your renewal.