Get Me Oias Nhw01 2007-2026

The ME OIAS NHW01 form is an essential application for individuals seeking financial assistance with nursing facility costs, home nursing care, or care in residential and assisted living facilities in Maine. This guide provides clear, step-by-step instructions to help users fill out the form accurately online.

Follow the steps to complete the ME OIAS NHW01 form effectively.

1. Press the ‘Get Form’ button to access the ME OIAS NHW01 form and open it in your preferred online editor.
2. Begin by filling out the section titled ‘Information about you.’ Enter your full name (first, middle, last), birthdate, social security number, and mailing address including street, city, state, and zip code.
3. Indicate your age, citizenship status, and sex. Provide a telephone or message number for contact purposes. Include the street address and town where you currently reside, along with directions to your home.
4. Complete the section regarding your race and marital status. If applicable, enter your Medicare number and indicate if you have a disability or receive Supplemental Security Income (SSI).
5. If you are married, provide your spouse’s information, including their name, Medicare number, and whether they live with you. Fill their social security number, sex, and birthdate as well.
6. Proceed to the asset section on pages 2 and 3. List your cash, checking, and savings accounts, and provide the corresponding balances. If you need additional space, check the option to use a separate sheet.
7. State whether you have a Patient Account if you are in a nursing or residential care facility and what the balance is. Disclose any annuities you or your spouse hold, including details specific to the MaineCare long-term care qualifications.
8. Continue by disclosing any stock, bonds, life insurance, and other properties that either you or your spouse may have. This includes vehicles and any recent disposal of personal property or financial accounts since February 8, 2006.
9. Provide information regarding any expected payments such as retroactive government benefits, compensation, or inheritance. List all forms of income for yourself and your spouse including alimony, social security, military allotments, etc.
10. If necessary, provide details about shelter expenses if you or your spouse incur any, including lot rent, mortgage, and utilities. Indicate any medical bills incurred within the last three months and if you or your spouse have medical insurance.
11. Complete the section regarding power of attorney, conservatorship, or guardianship if applicable, and provide their contact information along with anyone assisting you with this application.
12. Finally, review all the information you have entered, ensure accuracy, and provide your signature and date at the end of the form to certify the information is correct.
13. Once completed, save your changes, and choose to download, print, or share the form as necessary.

Complete your application online for financial assistance today.