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This document allows individuals to request the California Department of Health Services to restrict the use and disclosure of their Medi-Cal information.
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How to fill out DHS 6240

01
Obtain a copy of the DHS Form 6240 from the official website or local office.
02
Read the instructions carefully to understand the information required.
03
Fill out the personal information section, including your name, address, and contact details.
04
Provide detailed information about the purpose of the form, including specific details related to your application or request.
05
Attach any required supporting documents as specified in the instructions.
06
Review the completed form for accuracy and completeness.
07
Sign and date the form at the designated section.
08
Submit the form to the appropriate office or agency as instructed.

Who needs DHS 6240?

01
Individuals applying for certain immigration benefits.
02
People requiring documentation or adjustment of status with the Department of Homeland Security.
03
Applicants seeking to rectify errors or update information related to their immigration cases.
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DHS 6240 is a form used by the Department of Homeland Security (DHS) to collect information related to certain immigration and nationality matters.
Individuals or entities that are engaged in activities requiring reporting to DHS, typically including employers handling foreign national employees, need to file DHS 6240.
To fill out DHS 6240, carefully follow the provided instructions on the form, ensuring that all required fields are completed accurately and truthfully.
The purpose of DHS 6240 is to ensure compliance with immigration laws and provide the DHS with relevant information regarding foreign nationals and their employment status.
The information reported on DHS 6240 includes personal identification details, employment information, and specifics about the foreign national's visa status and related immigration matters.
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