HI DHS 1147 2009 free printable template

STATE OF HAWAII Department of Human Services Med-QUEST Division HEALTH SERVICES ADVISORY GROUP, INC. 1440 Kaplan Blvd., Suite 1110 Honolulu, HI 96814 Phone: (808) 440-6000 Fax: (808) 440-6009 STATE

How to fill out HI DHS 1147

How to fill out HI DHS 1147

1. Obtain the HI DHS 1147 form from the official Department of Human Services website or local office.
2. Begin filling out the applicant's personal information at the top of the form including name, address, and contact information.
3. Provide details about the individual's household, including the names and relationships of all household members.
4. Indicate the purpose of the application by checking the appropriate boxes.
5. Complete the income section by detailing all sources of income for the household members.
6. Include any additional information or documentation required, such as proof of income or identification.
7. Review the entire form for accuracy and completeness before signing at the bottom.
8. Submit the form as instructed, either by mailing it to the designated address or submitting it in person.

Who needs HI DHS 1147?

1. Individuals or families seeking assistance from the Hawaii Department of Human Services.
2. People applying for various benefits such as food assistance, financial aid, or other support services.

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What is HI DHS 1147?

HI DHS 1147 is a form used for reporting certain health insurance information in the state of Hawaii.

Who is required to file HI DHS 1147?

Entities such as health care providers or insurance companies that meet specific criteria set by the Hawaii Department of Human Services are required to file HI DHS 1147.

How to fill out HI DHS 1147?

To fill out HI DHS 1147, carefully follow the instructions provided with the form, ensuring that all required fields are completed accurately and submitted by the deadline.

What is the purpose of HI DHS 1147?

The purpose of HI DHS 1147 is to collect accurate data for reporting health insurance coverage and to assist in program management and evaluation by the state.

What information must be reported on HI DHS 1147?

The information required includes details about the insured individuals, coverage specifics, provider data, and any relevant policy information as outlined by the form's instructions.