Dhhs form 3400 b-2026

1. Click ‘Get Form’ to open the dhhs form 3400 b in the editor.
2. Begin by entering the name and Social Security Number of the person needing assistance in Section 1. Ensure accuracy as this information is crucial for eligibility determination.
3. In Section 2, indicate the current location of the individual—whether at home, a hospital, or a nursing home. If they are not at home, provide details about their current facility.
4. Proceed to Section 3 and check if anyone holds Conservatorship, Guardianship, or Power of Attorney for the applicant. If applicable, attach legal documentation.
5. Sections 4 through 6 require you to answer questions regarding income allocation and previous employment benefits. Be thorough in your responses to ensure all relevant information is captured.
6. Continue filling out Sections 7 through 10 by providing details about any additional income sources and assets owned by the applicant or spouse. Attach necessary proof as indicated.
7. Finally, review all sections for completeness and accuracy before signing at the end of the form. Use our platform’s features to save your progress and make edits as needed.

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