Hardship application with Authorized Rep form 2026

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  1. Click ‘Get Form’ to open the Hardship application with Authorized Rep form in our editor.
  2. Begin by providing your personal information in the 'Tell us about yourself' section. Fill in your first name, last name, address, and contact details. Ensure accuracy as this will be used for communication regarding your application.
  3. In the 'Tell us about your tax household' section, list all individuals who need an exemption. For each person, include their name, date of birth, social security number, and indicate if they need an exemption.
  4. Select the type of hardship you are claiming from the provided options. Be sure to include the start and end dates of your hardship where applicable.
  5. Review all entered information for accuracy. Print the completed application and sign it. If an authorized representative assisted you, ensure they complete their section as well.
  6. Finally, email or mail your signed application along with any required documentation to DC Health Link for processing.

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An undue hardship exists if the applicant/beneficiary can show that denying Medicaid long term care services, either institutional or home and community based services (HCBS) including through the Elderly and Persons with Disabilities (EPD) waiver or the Individuals with Developmental Disabilities waiver (IDD), would
Section A should be completed and signed by the patient. Section B should be completed by the Doctor and Pharmacist. The form should then be sent to your HSE Local Health Office.
Undue hardship is defined as an action requiring docHub difficulty or expense when considered in light of a number of factors. These factors include the nature and cost of the accommodation in relation to the size, resources, nature, and structure of the employers operation.

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