Get La Bhsf 1-l Ssi 2011-2025

This guide provides a clear and supportive approach to completing the LA BHSF 1-L SSI form online. Following this step-by-step process will help ensure that you accurately fill out the required information for long-term facility care, home and community-based services, or the Program of All-Inclusive Care for the Elderly.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the LA BHSF 1-L SSI form and open it in your browser.
2. Begin by filling in the name of the applicant who needs long-term care. Include their first name, middle initial, maiden name if applicable, and last name.
3. Enter the applicant's Social Security number and date of birth.
4. Select the marital status of the applicant. Options include 'Single', 'Married', 'Divorced', or 'Widowed'.
5. Indicate whether the applicant is a veteran by selecting 'Yes' or 'No'. If they are a veteran, provide the VA claim number.
6. Fill in the residence address of the applicant, including state and zip code.
7. Complete the mailing address if it differs from the residence address.
8. Identify the person responsible for handling the applicant's affairs by providing their name, phone numbers, email, and relationship to the applicant.
9. Indicate if the responsible person has power of attorney; select 'Yes' or 'No'.
10. Provide the current facility status of the applicant by selecting if they currently reside in a nursing facility or plan to enter one.
11. If applying for home and community-based services (HCBS), indicate this by selecting 'Yes' or 'No' and specify the type of HCBS being applied for.
12. If applicable, fill out information regarding any children under the age of 18 or a spouse living at home as this could impact the applicant's eligibility.
13. Report any income sources for the applicant or the applicant's spouse outside of Supplemental Security Income (SSI) and detail the amounts.
14. Confirm if the applicant or their spouse has received any lump sums or has bank accounts, providing necessary details if applicable.
15. Read and acknowledge the rights and responsibilities section, ensuring all information provided is truthful.
16. Sign and date the application, ensuring that any representative or witnesses also sign if applicable.
17. Finally, review the completed form, save any changes, and follow the instructions for printing or sharing the document as needed.

Complete the LA BHSF 1-L SSI form online today to expedite your application process.