3400 b-2025

1. Click ‘Get Form’ to open the 3400 b document in the editor.
2. Begin by entering the applicant's name and Social Security Number in the designated fields. Ensure accuracy as this information is crucial for eligibility assessment.
3. Indicate the current location of the applicant by selecting from options such as Home, Hospital, or Nursing Home. Fill in the Date of Birth and any relevant facility details.
4. If applicable, check boxes for Conservatorship, Guardianship, or Power of Attorney and provide necessary contact information for these individuals.
5. Address income allocation questions regarding a spouse or dependents by selecting 'Yes' or 'No' and providing additional details if necessary.
6. Complete sections on past employment benefits and other income sources by checking relevant boxes and filling out the accompanying table with detailed information.
7. List any owned assets by checking appropriate boxes and providing descriptions, values, and locations as required.
8. Finally, review all entries for accuracy before signing at the end of the form to confirm completion.

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