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Get CMSP 207 2006-2024

Medi-Cal Linkage Evaluation Form CMSP 1153 Read complete and return to our office. A self-addressed stamped envelope is included for you to return the Statement of Facts CMSP 219 and CMSP 1153 forms with all verifications necessary to the Social Services office. CMSP REAPPLICATION COVER LETTER Date Case Name Case Number Worker Name Worker Phone Number In order to process your reapplication for County Medical Services Program CMSP benefits you need to complete and return to our office the following papers that are enclosed q Statement of Facts You need to read over the Statement of Facts for your case and make sure that the information listed there is correct. o Attach the most current income verification such as your most current pay stub a copy of your most current tax return papers if self-employed the most current statement from Veterans Office etc* Provide current verification of any stocks bonds mutual funds trust deeds and other real property. Update or correct the information that is on your Statement of facts. You must initial every change that you make in the margin next to the change. After you review the updated Statement of Facts you must sign and date the last page and return it to our office. If you claim any deductions from your income such as child care costs health insurance premiums alimony self-employment expenses etc* you need to provide current verifications. Rights Responsibilities and Other Information CMSP 219 Read and then sign and date the last page and return the signed last page to our office. A copy of your Application for CMSP SAWS1 is also included for your records. You do not need to return the SAWS1 form to us. You need to complete the above mentioned forms and return them by or If you have any questions please contact your worker at the number listed on the top of the form* Thank you. CMSP REAPPLICATION COVER LETTER Date Case Name Case Number Worker Name Worker Phone Number In order to process your reapplication for County Medical Services Program CMSP benefits you need to complete and return to our office the following papers that are enclosed q Statement of Facts You need to read over the Statement of Facts for your case and make sure that the information listed there is correct. o Attach the most current income verification such as your most current pay stub a copy of your most current tax return papers if self-employed the most current statement from Veterans Office etc* Provide current verification of any stocks bonds mutual funds trust deeds and other real property. o Attach the most current income verification such as your most current pay stub a copy of your most current tax return papers if self-employed the most current statement from Veterans Office etc* Provide current verification of any stocks bonds mutual funds trust deeds and other real property. Update or correct the information that is on your Statement of facts. You must initial every change that you make in the margin next to the change. Update or correct the information that is on your Statement of facts. You must initial every change that you make in the margin next to the change. After you review the updated Statement of Facts you must sign and date the last page and return it to our office. .

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