H3034 2025

1. Click ‘Get Form’ to open h3034 in the editor.
2. Begin by filling out the 'Identificación del caso' section. Enter your full name, case number, date of birth, Social Security number, and sex.
3. Provide your spouse's name if applicable, along with your city or town of residence.
4. In the 'Nombre del especialista en elegibilidad' section, input the eligibility specialist's name and their contact information including phone number and extension.
5. Select the relevant program from the options provided such as Prior Medical or Emergency Medical Benefits.
6. Indicate the month needed for onset of eligibility and provide the application date.
7. Complete sections regarding your occupation, preferred language for communication, and educational background.
8. Finally, add any comments regarding your disability and indicate whether you graduated from university.

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