Get Nd Sfn 783 2017-2026

The ND SFN 783 form is the application for the North Dakota Substance Use Disorder Voucher, designed to provide individuals with access to vital treatment services. Completing this form accurately is essential for ensuring you receive the support you need for substance use recovery.

Follow the steps to fill out the ND SFN 783 online.

1. Click the ‘Get Form’ button to access and open the ND SFN 783 online in your chosen editor.
2. Begin by filling in the applicant information section. Provide your name (first, middle initial, last), date of birth, and eligibility update details, including your age. Enter your current address, telephone number, cell phone number, and social security number if you choose to disclose it.
3. Complete the demographic information section. Indicate your gender, marital status, and military service status. Select your race and tribal affiliation, if applicable. Provide your education level and living environment status.
4. In the income verification section, report your annual household income based on your last tax return. Input your household size and your employment status, including position and current employer details.
5. Continue with any additional sources of income, and list assets such as savings accounts and retirement accounts.
6. For health care coverage information, indicate if you have Medicaid or Medicare, including any third-party insurance coverage. Complete the necessary fields regarding coverage and policy details.
7. In the applicant needs section, describe your present needs related to substance use disorder treatment in detail, including current symptoms.
8. Sign the application by typing your name in the applicant signature section, attesting to the accuracy of the information provided.
9. If applicable, the provider signature section should be filled out by the substance use disorder treatment provider, confirming the need for services.
10. Review all entries for accuracy, then save your changes. You can download, print, or share the completed form as needed.

Start completing the ND SFN 783 online today to access essential substance use disorder services.