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- Click ‘Get Form’ to open it in the editor.
- Begin with Section 1, where you will provide your personal information. Fill in the date, your name, and address accurately.
- In Section 2, list family members and tax dependents living in your household. For each person, indicate if they expect to file a tax return and whether they are pregnant or have Medicaid.
- Proceed to Section 3 to provide additional details about income and living situations for those listed. If applicable, complete Attachment B for income details.
- Finally, sign the form in Section 4 under penalty of perjury, confirming that all information is true to the best of your knowledge.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2016 | 4.8 Satisfied (162 Votes) |
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