Get Ny Doh-5080 2019

The NY DOH-5080 form is essential for seniors seeking assistance with prescription drug costs through the Elderly Pharmaceutical Insurance Coverage (EPIC) program in New York. This guide provides step-by-step instructions to help users successfully complete the form online.

Follow the steps to complete the NY DOH-5080 application online.

1. Press the ‘Get Form’ button to access the NY DOH-5080 form and open it for editing.
2. Begin by providing your personal information in the designated fields. This includes your name, date of birth, and contact information.
3. Indicate your marital status accurately. Check 'Single', 'Married', or 'Divorced' based on your situation.
4. Fill out the income section. Lines 1-3 require reporting your total income from the previous year. If married and living together, include your spouse’s income.
5. Proceed to report your current monthly income on lines 4-9. Enter amounts from various sources such as Social Security, pensions, and additional income while ensuring to estimate accurately.
6. In the assets section (lines 11-14), specify your current balances in bank accounts and investments. Exclude your home and personal belongings.
7. Complete the section regarding other expenses and earnings. Answer the questions according to your financial situation.
8. Review the application carefully for completeness and accuracy. Ensure that any required determination letters are attached if applicable.
9. Once all fields are filled out correctly, finalize your application. You can save changes, download, or print the completed form for submission.

Submit your completed NY DOH-5080 application online to apply for EPIC benefits.