Dhs 4574 b fillable 2013 form-2026

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4.3 out of 5

29 votes

The document is an 'Assets Declaration' form used by the Michigan Department of Human Services to collect information about the assets owned by a patient and their spouse. This information is necessary to assess eligibility for Medicaid and determine asset protection for the spouse. The form includes sections for personal details, types of assets, vehicles, and declarations regarding any recent financial transactions or changes in asset ownership. It also contains an affidavit section where the signer affirms the truthfulness of the provided information.

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Click ‘Get Form’ to open the Dhs 4574 b fillable 2013 form in the editor.
Begin by entering the Grantee Name and Client ID at the top of the form. If applicable, include your spouse's information by filling in their details as prompted.
Proceed to complete the Patient’s Name, Birthdate, and Social Security Number. Ensure all entries are accurate for proper processing.
In the Assets section, indicate whether anyone in your household has assets by checking 'Yes' or 'No'. If 'Yes', check all applicable asset types and provide detailed information in the table provided.
Continue through the vehicle section, marking any vehicles owned and providing necessary details such as year, make/model, and amount owed.
Complete the affidavit section by signing and dating where indicated. If signed on behalf of someone else, ensure to fill out their relationship and contact information.

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Versions	Form popularity	Fillable & printable
2016	4.9 Satisfied (504 Votes)
2013	4.3 Satisfied (29 Votes)

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What is supplementary certificate de-2525XX?

If you have not fully recovered and need to continue your benefits, you must submit a Physician/Practitioners Supplementary Certificate (DE 2525XX) with your final payment. Have your physician/practitioner complete and submit this claim form to find out if you are eligible for an extension.

Where can I get a DE 2525XX form?

BAM 110 : Introduction to Accounting - California Coast University. California Coast University.

How to get a free disability form?

Online; or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office. An appointment is not required, but if you call ahead and schedule one, it may reduce the time you spend waiting to apply.

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Why wont my doctor fill out my disability forms?

Common Reasons Doctors Dont Complete Disability Paperwork The doctor may not believe your medical condition is severe enough to cause disability. The doctor may not want to get involved in a legal battle or be called to testify. The doctor may not have the time to complete extra paperwork.

How to get forms from EDD?

To search and order brochures and forms from the EDD, visit Online Forms and Publications. All are available at no cost, whether you download or order for delivery by mail.

Dhs 4574 b fillable 2013 form-2026

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