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  • Mo Im-1 2018

Get Mo Im-1 2018-2026

FOR OFFICE USE ONLYMISSOURI DEPARTMENT OF SOCIAL SERVICES FAMILY SUPPORT DIVISIONAL RECEIVEDAPPLICATION FOR MEDICARE SAVINGS FOR QUALIFIED BENEFICIARIES OR SPECIFIED INCOME BENEFICIARIES DCN #1DCN.

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How to fill out the MO IM-1 online

Completing the MO IM-1 form online is an essential step for individuals seeking Medicare savings. This guide provides clear instructions to assist users in accurately filling out each section of the application.

Follow the steps to effectively complete the MO IM-1 form.

  1. Click the ‘Get Form’ button to access the form and open it in your form editor.
  2. Begin by filling out the applicant's name, including first, middle, and last names. Ensure accuracy to avoid delays.
  3. Provide your complete address, including house number, street or rural route, and city, state, and zip code.
  4. Enter both home and work phone numbers, along with any additional contact numbers.
  5. If married, fill out the spouse's information, including name and relevant details like race, birthdate, and social security number.
  6. Answer the questions regarding citizenship and residency in Missouri, making sure to clarify if you are applying for your spouse as well.
  7. List any other health insurance you may have, providing the insurance company's name, policy number, and type of coverage.
  8. Report employment details for yourself and your spouse, including the amount earned before deductions and the name of the employer.
  9. Disclose any additional income sources and list cash, securities, and personal property, following the detailed instructions provided.
  10. Complete the vehicle information section, ensuring all owned vehicles are listed accurately.
  11. Review the application for completeness and accuracy. Make any necessary edits before finalizing your application.
  12. Sign and date the application at the designated areas. Ensure all required signatures are recorded.
  13. Once completed, save changes, download the document for your records, print it if necessary, or share it as required.

Start completing your MO IM-1 application online today to ensure your Medicare savings are processed promptly.

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