Get Ar Dhs Dco-777 2012-2026

Filling out the AR DHS DCO-777 form is an essential step for individuals seeking long-term care assistance in Arkansas. This guide provides clear, step-by-step instructions to help you navigate the online application process smoothly.

Follow the steps to complete the AR DHS DCO-777 form online

1. Click the ‘Get Form’ button to access the AR DHS DCO-777 form and open it in your preferred online document editor.
2. Indicate if you are a resident of Arkansas by selecting 'Yes' or 'No'.
3. Provide your full name, including first, middle, and last names. Fill in your race and sex as required.
4. Input your current address, including physical address, city, state, zip code, and county. If you have a mailing address different from your physical address, fill that in as well.
5. Specify how long you have lived at your current address in years.
6. Enter your telephone number.
7. Fill in your Social Security number, Medicare number, and any relevant identification numbers.
8. Confirm your citizenship status by selecting 'Yes' or 'No'.
9. Indicate your marital status by choosing the appropriate option from married, single, separated, divorced, or widowed.
10. Complete questions 11 to 15 only if you have a spouse. Provide your spouse’s details as requested, including name, address, telephone number, and social security number.
11. Outline your and your spouse's sources of income in question 16, marking 'Yes' or 'No' for each income type and providing relevant amounts and frequencies.
12. Answer questions about any previous SSI received and expected changes in income.
13. Indicate if you or your spouse own a home or other real properties, providing equity values and addresses as necessary.
14. List any vehicles or personal property owned, including their value.
15. Complete the asset section regarding cash, accounts, insurance, and other financial resources.
16. Respond to additional queries about health insurance, unpaid medical expenses, and long-term care insurance.
17. Review all information for accuracy, then follow the prompts to submit the form online.
18. Finally, save your changes, download a copy of the form for your records, or print it directly.

Encourage others to complete their documents online for a seamless experience.