Mdhhs Form 1004

• Category: Court Samples - Divorce - With Children - Sample Case 1
• State: Texas
• Control #: TX-CC-21-05
• Format: PDF

Description dhs 1004 health care coverage supplemental questionnaire

A05 Final Decree of Divorce

MD HHS Form 1004, also known as the "Michigan Department of Health and Human Services Form 1004," is a document used by the Michigan state government to collect important information from individuals applying for various assistance programs and services. This detailed form aids MD HHS in determining an individual's eligibility for health care, food assistance, childcare, and other crucial benefits. The MD HHS Form 1004 is an essential tool for gathering relevant details about an applicant's personal, financial, and household information. It consists of several sections and fields, ensuring comprehensive data collection for an accurate evaluation process. The form typically requires applicants to provide information such as their full name, address, contact details, date of birth, Social Security number, and citizenship or immigration status. Furthermore, the MD HHS Form 1004 includes sections where applicants must disclose their income, employment status, and details about other household members. This data helps MD HHS assess the overall financial situation and determine the level of assistance needed. It may also require applicants to submit supporting documents, such as wage statements, tax returns, utility bills, and proof of residency. Among the different types of MD HHS Form 1004 are variations designed for specific assistance programs and services. Some notable forms include: 1. MD HHS Form 1004CB: This variant is specifically tailored for applicants seeking Childcare Assistance Program benefits. It collects additional information about child care needs, employment, and the chosen child care provider. 2. MD HHS Form 1004EXB: This version is used for determining eligibility and enrollment in the Emergency Relief Program. It gathers essential details about an individual or family facing immediate financial hardship. 3. MD HHS Form 1004F: Designed for the Food Assistance Program, this form focuses on information regarding the applicant's income, expenses, and household composition to assess eligibility for food assistance benefits. 4. MD HHS Form 1004HB: This particular variant is dedicated to gathering data for the Home Heating Credit Program. It requires detailed information about the primary heating source, energy expenses, and household income. 5. MD HHS Form 1004MA: This form is utilized for assessing eligibility for Medicaid and Healthy Michigan Plan benefits. It collects essential information related to income, assets, medical expenses, and health insurance coverage. In summary, MD HHS Form 1004 is a critical document used by the Michigan Department of Health and Human Services for collecting detailed information from individuals applying for various assistance programs and services. The form ensures accurate evaluations of an applicant's eligibility and helps in determining the appropriate level of benefits provided. Different variations of the form cater to specific assistance programs such as child care, emergency relief, food assistance, home heating, and Medicaid/Healthy Michigan Plan benefits.