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Get Application, Certification And Renewal
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How to fill out the APPLICATION, CERTIFICATION AND RENEWAL online
This guide outlines the process for filling out the APPLICATION, CERTIFICATION AND RENEWAL for the Family Planning Benefit Program (FPBP) online. Follow these steps for a clear and effective completion of your application.
Follow the steps to successfully complete the application online.
- Click the ‘Get Form’ button to access the application form and open it in your browser.
- Begin by filling in your personal information in the designated fields, including your name, date of birth, and contact details. Ensure all information is accurate.
- Indicate your current financial situation by providing details regarding your income and household size. This information is crucial for determining your eligibility for the FPBP.
- If you are under the age of 21 and living with your parents, note that you may need to provide your parents' financial information. If confidentiality is a concern, clearly mark ‘confidential’ on your application.
- Review the benefits available under Medicaid and Family Health Plus; if you wish to apply for these programs, ensure that you do so at this point before completing the FPBP application.
- Sign the 'Declination of Medicaid and Family Health Plus Eligibility Determinations' statement on the back of the application if you choose to proceed with only the FPBP.
- After completing the form, review all entries for clarity and correctness; make any necessary corrections before finalizing.
- Save changes to the form, and then download, print, or share the application as needed for submission.
Complete your APPLICATION, CERTIFICATION AND RENEWAL online today to access family planning benefits.
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