Get Mo Mo 650-5828n 2002-2026

The MO MO 650-5828N form is essential for individuals seeking reimbursement for interim assistance from the Missouri Department of Mental Health following the approval of Supplemental Security Income (SSI) benefits. This guide will provide you with a clear and structured approach to completing the form online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated field. Ensure that your name matches the one on your official identification documents.
3. Input your Social Security number in the respective section. Make sure you enter this information accurately, as it is critical for processing your request.
4. Fill in your address, including the city, town, and ZIP code. This information will help the State communicate with you effectively.
5. Select the appropriate block based on your needs: either 'Initial Payment Only' or 'Initial Posteligibility Payment Only.' Ensure you check only one option, as checking both renders the form invalid.
6. If you selected 'Initial Payment Only,' review the authorization that it allows, which includes receiving your retroactive SSI payment or a similar amount for reimbursable assistance.
7. If you opted for 'Initial Posteligibility Payment Only,' confirm the authorization for the posteligibility SSI payment under similar terms.
8. Complete the signature section by signing and dating the form. The state representative must also sign and date the form for it to be valid. Both signatures are required for authorization.
9. After reviewing all filled sections for accuracy, you can save changes, download, print, or share the form as needed.

Complete your documents online confidently and ensure your applications are submitted correctly.