Follow the steps to complete the application successfully.

1. Press the ‘Get Form’ button to download the application form and open it in your preferred online editor.
2. Begin by indicating where you have received care by checking all applicable options listed, such as Minneapolis, St. Paul, or other locations. This information helps to establish the context of your application.
3. Next, answer the questions regarding Minnesota Healthcare Programs. Indicate if you have recently applied for Medical Assistance or MinnesotaCare by selecting 'Yes' or 'No'. Also, specify if anyone in your household is pregnant.
4. In the Applicant section, identify the person responsible for paying the bill. Fill in their name, date of birth, address, and contact details. Indicate your relationship status as a single parent if applicable.
5. Provide details regarding the applicant's employer(s) and ensure to include proof of income reflecting the last three months, with specific notes regarding income from farming or ranching.
6. Proceed to the Co-Applicant section if applicable, filling out similar information as required for the applicant, including name, date of birth, and employer(s).
7. List all children who are dependents as indicated on your Federal Tax Return. Include their names, dates of birth, and whether they are U.S. residents. Indicate if each child is a patient.
8. Fill out the Monthly Income and Assets section. Provide amounts for various income sources, such as child support, disability benefits, and rental income, noting who receives each benefit.
9. Complete the Authorization section by declaring that the information provided is accurate to the best of your knowledge. Both the applicant and co-applicant should sign the form, along with the date.
10. Finally, save any changes made to the application. You will have the option to download the completed form, print it for your records, or share it as needed.

Start your application process online today to secure the financial assistance your child deserves.