Dhs 3876 eng-2026

1. Click ‘Get Form’ to open the DHS-3876 ENG application in the editor.
2. Begin by reading the Notice of Privacy Practices and Notice of Rights and Responsibilities included in the form. Tear off and keep these notices for your records.
3. Fill out all required fields, starting with personal information such as your first name, last name, date of birth, and Social Security number if applicable. If you need more space for any answers, write them on a separate piece of paper and attach it.
4. Complete sections regarding household members applying for health care coverage. Include their names, dates of birth, and relationships to you. Ensure to indicate if they want health care coverage.
5. Provide details about your income, assets, and any other relevant financial information as prompted in the form. Attach copies of necessary proofs but do not send original documents.
6. Sign and date the application at the designated section before submitting it through mail or in person to your county or tribal agency.

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