Dma 5200 application-2026

1. Click ‘Get Form’ to open the dma 5200 application in the editor.
2. Begin by filling out Step 1, which requires your personal information. Enter your first name, middle name, last name, and suffix. Provide your home address, city, state, ZIP code, and county.
3. Proceed to Step 2 where you will list family members who need coverage. Include yourself, spouse, children under 21 living with you, and anyone claimed on your tax return.
4. For each family member listed in Step 2, provide their details including relationship to you, date of birth, sex, and Social Security number if applicable.
5. Continue through the form by providing current job and income information for each person as required in the subsequent sections.
6. Once all sections are completed accurately, review your entries for any errors before signing the application at Step 5.
7. Finally, submit your completed application by taking or mailing it to your local County Department of Social Services.

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