5147 form-2025

Get Form
5147 form Preview on Page 1

Here's how it works

01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

How to modify 5147 form online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

With DocHub, making adjustments to your documentation takes only some simple clicks. Follow these fast steps to modify the PDF 5147 form online for free:

  1. Register and log in to your account. Sign in to the editor with your credentials or click Create free account to evaluate the tool’s functionality.
  2. Add the 5147 form for redacting. Click on the New Document option above, then drag and drop the sample to the upload area, import it from the cloud, or via a link.
  3. Alter your document. Make any adjustments required: insert text and photos to your 5147 form, highlight details that matter, erase sections of content and substitute them with new ones, and add icons, checkmarks, and fields for filling out.
  4. Complete redacting the form. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is super easy to use and effective. Try it out now!

See more 5147 form versions

We've got more versions of the 5147 form form. Select the right 5147 form version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2021 4.8 Satisfied (141 Votes)
2015 4.3 Satisfied (146 Votes)
2014 4 Satisfied (21 Votes)
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
If you are under 21 years of age, over 65 years of age, certified blind, certified disabled, pregnant, or a parent of a child under 21 years of age, you may be eligible for Medicaid if your income is above these levels and have medical bills.
You may apply for Medicaid coverage yourself, or you may designate another person, such as a family member, your attorney, or a friend, to apply for you.
People who are certified blind, certified disabled, or age 65 or older who have more resources may also be eligible. If an adult has too much income and/or resources and is not eligible for Medicaid, they may be eligible for the Family Planning Benefit Program.
(Supplement to Access NY Health Care Application DOH-4220) This Supplement must be completed if anyone who is applying is: Age 65 or older Certified blind or certified disabled (of any age) Not certified disabled but chronically ill Institutionalized and applying for coverage of nursing home care.
IB-Dual allows members who are Medicare eligible to remain in their Mainstream Medicaid Managed Care health plan. You will receive both your Medicaid services and Medicare benefits through your current health plan as a dual-eligible beneficiary.
be ready to get more

Complete this form in 5 minutes or less

Get form

People also ask

Options include mailing the application to the local Medicaid office, submitting it in person, or submitting it online through the New York State of Health website. Application review: After the application is submitted, it will be reviewed by the Nassau County Department of Social Services.

Related links