Tefra medicaid sc: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the top section with the date, worker's name, telephone number, and case details. Ensure all information is accurate.
In Section 1, provide detailed information about the child receiving TEFRA, including their full name, mailing address, social security number, and date of birth.
Proceed to Section 2 to enter details about the child's parents or guardian. Include names, races, and relationships to the child.
In Section 3, indicate whether the TEFRA child works or is self-employed. If applicable, provide income details and attach proof of income.
Section 4 requires you to list any other income received by the TEFRA child. Be sure to write 'none' if not applicable.
For Section 5, check if the TEFRA child has any assets or resources. Provide necessary details and values for each asset listed.
Finally, review your entries for accuracy before submitting. Attach any required documentation as specified in the form.

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