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MI DHS-3380 2012-2026 free printable template

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Case Name: Case Number: Date: DHS Office: / Specialist / ID: Phone: Fax: Individual ID: ENTER ADDRESSEE Department of Human Services (DHS) will not discriminate against any individual or group because
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How to fill out MI DHS-3380

01
Obtain the MI DHS-3380 form from the Michigan Department of Health and Human Services website or local office.
02
Read the instructions carefully to understand the purpose of the form.
03
Fill out your personal information in the designated sections, including your name, address, and date of birth.
04
Provide details regarding your family members and their information, if applicable.
05
Complete any sections related to your income, benefits, and health care needs.
06
Review all entered information for accuracy and completeness.
07
Sign and date the form before submission.
08
Submit the form to the appropriate Michigan DHS office either in person or by mail.

Who needs MI DHS-3380?

01
Individuals applying for public assistance programs in Michigan.
02
Families seeking services from the Michigan Department of Health and Human Services.
03
People who need to report changes in their personal circumstances related to benefits.
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MI DHS-3380 is a form used by the Michigan Department of Health and Human Services for assessing and documenting the needs of individuals requiring financial assistance.
Individuals applying for certain types of assistance programs, such as food assistance, Medicaid, or cash assistance, are required to file MI DHS-3380.
To fill out MI DHS-3380, complete all sections of the form by providing accurate and detailed information about your personal, household, and financial circumstances. Follow any instructions provided by the Michigan Department of Health and Human Services.
The purpose of MI DHS-3380 is to gather information necessary for determining eligibility for various assistance programs and to assess the individual's specific needs and circumstances.
Information that must be reported on MI DHS-3380 includes personal identification details, household composition, income, expenses, and any specific needs or circumstances relevant to the assistance being requested.
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