Get Md Dhs/fia 9709r 2017-2025

This guide provides step-by-step instructions on completing the MD DHS/FIA 9709R form for long-term care waiver medical assistance. It aims to assist users in accurately filling out each section of the form online.

Follow the steps to successfully complete the MD DHS/FIA 9709R online.

1. Press the ‘Get Form’ button to obtain the MD DHS/FIA 9709R form and open it in the online editor.
2. Begin by filling out section A, which includes identifying information such as the recipient's name, date of birth, social security number, and contact information. Ensure the information is accurate and complete.
3. In section B, report the recipient’s income. Attach current verifications for each type of income reported, including social security, wages, and any additional sources.
4. Complete section C for the spouse’s income, if applicable. Like section B, include current verifications for the spouse's income sources.
5. Fill out section D, detailing the spouse’s shelter expenses, and ensure you attach necessary proof of these expenses.
6. Move to section E to provide information on any dependents’ income, again attaching current verifications.
7. In section F, disclose all assets owned by the recipient. This includes bank accounts, real estate, and other valuable assets. Attach reliable verification for each asset.
8. Proceed to section G, indicating if the recipient has any non-covered medical expenses, and include documentation for these expenses.
9. In section H, provide details regarding the recipient's medical insurance, including Medicare and any other health insurance policies held. Attach verification of premium amounts.
10. Complete section I, which requires attaching the recipient’s recent federal tax returns and any additional necessary financial documentation.
11. Finally, ensure to read and understand the rights and responsibilities included, then complete the signature section to officially submit the application.
12. After completing the form, you can save changes, download, print, or share the completed MD DHS/FIA 9709R as needed.

Take action today and complete your MD DHS/FIA 9709R application online for timely processing.