Nce: ID# Food Stamps Other, list: Do you have unpaid medical bills now? YES NO 1. IDENTIFYING INFORMATION Last Name First Name Middle Name What language do you speak? Are you visually impaired YES NO 2. ADDRESS Where do you live? Number Jr., III, etc. Maiden/Other Name Do you need an interpreter? Are you hearing impaired? Street City YES YES NO NO Apt No. Floor No. Telephone Number State Zip Code + 4 Number where you can be reached during the day 3. MAIL.

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How to fill out the MD DHR/FIA 9702 online

Filling out the MD DHR/FIA 9702 form online is an essential step for individuals seeking assistance through Maryland's Department of Human Resources. This guide will provide clear, step-by-step instructions to help users navigate the form effectively.

Follow the steps to complete the MD DHR/FIA 9702 form online:

  1. Press the ‘Get Form’ button to access the MD DHR/FIA 9702 form and open it in your preferred online editor.
  2. Begin by filling out your identifying information in section 1. This includes your last name, first name, middle name, and preferred language. Indicate if you have any visual or hearing impairments and if you require an interpreter.
  3. In section 2, provide your residential address, including street, city, state, and zip code, as well as a telephone number where you can be reached during the day.
  4. If your mailing address differs from your residential address, complete section 3 with the relevant mailing information.
  5. In section 4, list your previous addresses and the duration of your residency at each.
  6. Section 5 allows for the designation of an authorized representative. Fill this in if someone will assist you with the application process.
  7. Complete section 6 with individual information, including Social Security numbers, date of birth, marital status, and whether you are a U.S. citizen.
  8. In section 7, indicate whether you are a migrant worker or boarder.
  9. Provide information about your school status in section 10 if applicable. Include your educational level and the school name.
  10. Fill in section 11 regarding any disabilities you may have and list medical insurance details in section 12.
  11. Sections 13 to 23 cover various financial and asset details, including your income, liquid assets, and shelter costs. Fill these out as completely as possible.
  12. Review your entries for accuracy, then save your changes, download the completed form, or print it for your records.

Start completing the MD DHR/FIA 9702 form online today!

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MD DHR/FIA 9702 Form

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