Get Ca Dhcs 6195 2019-2026

Filling out the CA DHCS 6195 form online is an essential step in applying for a hardship waiver related to estate claims. This guide will provide you with clear, step-by-step instructions to successfully complete the application.

Follow the steps to successfully complete the CA DHCS 6195 form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin with Section A, where you will need to provide decedent's estate information. Fill in all applicable fields, including the decedent’s name and DHCS account number.
3. Indicate if the estate property is held in a trust or if there is a will. Attach required documents such as the trust document or will if applicable.
4. Provide details about the estate property, including its street address, market value, mortgage owed, and whether the property is listed for sale. If it has been sold, attach a copy of the settlement statement.
5. List any other assets in the decedent’s name at the time of death, such as bank accounts and life insurance policies. Provide attachments as needed to substantiate your claims.
6. Move to Section B to fill out the applicant information. Provide your full name, Social Security number, address, date of birth, and relationship to the decedent.
7. Proceed to Section C and check all applicable criteria for the hardship waiver. Ensure to provide the requisite documentation and complete any additional sections as required.
8. Complete Section D if applying under criteria 2 or 6B. List your monthly income sources and submit the necessary documentation.
9. If necessary, complete Section E for monthly expenses, providing details about your total monthly expenses and attaching relevant documentation.
10. In Section F, declare the value of your assets as instructed, only if applying under criteria 6B.
11. Finish by completing Section G, the certification section, ensuring to acknowledge the accuracy of the information provided. Sign and date the form.
12. Finally, you can save changes, download, print, or share the completed form as needed.

Apply for your hardship waiver by filling out the CA DHCS 6195 form online today.