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Statement of facts form 2026

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The document is an application form for individuals aged 18 to 26 who were in foster care on their 18th birthday, allowing them to apply for Medi-Cal benefits under the Affordable Care Act. It outlines eligibility requirements, including that applicants do not need to provide proof of income or resources. The form must be submitted to the local county social services department, and it includes instructions for notifying the county of any changes in living arrangements or address.

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Click ‘Get Form’ to open the statement of facts form in our editor.
Begin by entering your personal information, including your name, date of birth, and gender. Ensure accuracy as this information is crucial for processing your application.
Fill in your contact details, including telephone number and address. If you have a different mailing address, provide that as well to ensure proper communication.
Indicate the state where you were in foster care. This is important for eligibility verification under the Affordable Care Act.
Review the declaration statement carefully. By signing it, you affirm that all provided information is true and correct to the best of your knowledge.
Once completed, download or print the form directly from our platform for submission to your local county social services department.

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2014	4.8 Satisfied (40 Votes)

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statement of facts form california

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