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Dhhs form 3400 b-2026
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- Click ‘Get Form’ to open the DHHS Form 3400 B in the editor.
- Begin by entering the name of the person needing assistance, along with their Social Security Number and Medicaid ID. Ensure accuracy as this information is crucial for eligibility determination.
- Proceed to Section I, where you will answer questions regarding any financial transfers made in the past five years. If applicable, provide details about closed accounts and property transfers.
- In Section II, indicate if anyone has Conservatorship or Power of Attorney for the applicant. This section may require additional documentation, so be prepared to upload relevant legal papers.
- Complete all sections thoroughly, ensuring that you check all applicable boxes and provide necessary details about income sources and assets. Use our platform's features to easily navigate between sections.
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dhhs form 3400 a
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