Get Application Check List - Utah Department Of Workforce Services ...

This guide provides clear and supportive instructions on how to complete the Application Check List for the Health Coverage Tax Credit (HCTC) Bridge Payment through the Utah Department Of Workforce Services. Following these steps will help ensure that you gather and submit the required information correctly.

Follow the steps to complete your application checklist online.

1. Press the ‘Get Form’ button to access the Application Check List. This will allow you to view and fill out the necessary fields within the document.
2. Begin by entering your personal information in the designated fields. You will need to provide your name and any other required personal details.
3. Verify your age by attaching a photocopy of your Driver’s License or Birth Certificate for each eligible family member. This documentation is essential for the eligibility assessment.
4. Next, input your eligibility information. Provide the Pension Benefit Guaranty Corporation (PBGC) details, including either a PBGC check stub or a letter from PBGC confirming your payment status.
5. Compile your health plan information. Include any coupons, invoices, or bills related to your health coverage. Ensure that all relevant information is attached.
6. If applicable, provide COBRA Health Plan information. Make two copies of the essential documents, ensuring that your Social Security Number is on the federal copies. This includes a signed COBRA election form and proof of payment.
7. Complete the Federal HCTC Application as soon as you receive it in the mail. This step is crucial for final eligibility confirmation.
8. After filling in all necessary fields and attaching appropriate documents, review the application checklist one last time to verify accuracy. You can then save your changes, download, print, or share the completed form as needed.

Start filling out your Application Check List online today to ensure your HCTC eligibility.