Get Ccs Numbered Letter 15-1206. Supplement To Numbered Letter (n.l.) - Dhcs Ca

This guide provides clear instructions on how to accurately fill out the CCS Numbered Letter 15-1206, which serves as a supplement to existing policy letters regarding California Children's Services. Users will find a step-by-step approach tailored for ease of understanding.

Follow the steps to complete the CCS Numbered Letter 15-1206 form.

1. Click ‘Get Form’ button to obtain the CCS Numbered Letter 15-1206 form and access it in your preferred digital format.
2. Begin by filling in the patient name in the field labeled 'Patient Name: ____________________.' Ensure that the name matches official records.
3. Enter the patient’s date of birth in the provided space labeled 'Date of Birth: __________________.' This is crucial for identification.
4. Fill in the CIN (Client Identification Number) in the designated section labeled 'CIN#:_________________________.' This number is specific to the patient.
5. Provide the CCS (California Children's Services) number in the space marked 'CCS#: _______________________.'' This is necessary for processing.
6. State your family's annual household income by selecting the appropriate option. If using the tax return, refer to the adjusted gross income on the relevant line of form 540A or 540, and write the figure next to the chosen option.
7. If applicable, indicate that you did not file taxes last year and provide your gross monthly income in the specified section.
8. Sign the form as the applicant, parent, or legal guardian in the allocated area labeled 'Signature of Applicant/Parent/Legal Guardian.' Include the date signed.
9. If a county staff member assists telephonically, they must sign in the appropriate area and include the date signed.
10. Confirm that the information provided is only for verifying eligibility and will not affect service payments, if applicable.
11. Finally, review the completed form for accuracy and save your changes, download the document, print a copy, or share as necessary.

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