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This document is used by nursing facilities to notify the Department of Social Services within 15 days of a resident's death, collecting necessary information regarding the deceased, their family,
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How to fill out estate recovery program notification
How to fill out ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH
01
Obtain the ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH form.
02
Fill in the deceased's full name in the designated area.
03
Provide the date of death in the correct format.
04
Include the deceased's social security number for identification purposes.
05
List the address of the deceased at the time of death.
06
Indicate the name and contact information of the person submitting the form.
07
Sign and date the form to certify the information is accurate.
08
Submit the completed form to the designated estate recovery department.
Who needs ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH?
01
Family members or representatives of a deceased individual who received state assistance.
02
Executors or administrators of an estate who are required to notify the state of the death.
03
Legal guardians or authorized agents acting on behalf of the deceased.
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What is ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH?
The Estate Recovery Program Notification of Death is a legal document used to inform a state's estate recovery program about the death of an individual who received Medicaid benefits. This notification allows the state to assess any outstanding claims against the estate.
Who is required to file ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH?
Typically, the executor or administrator of the deceased person's estate is required to file the Estate Recovery Program Notification of Death, or any representative as designated by the deceased or appointed by the court.
How to fill out ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH?
To fill out the Estate Recovery Program Notification of Death, you need to provide information such as the deceased's full name, date of birth, date of death, and the details about Medicaid benefits received. It is important to ensure accuracy and completeness in the information provided.
What is the purpose of ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH?
The purpose of the Estate Recovery Program Notification of Death is to notify the state of the individual's passing, enabling the state to initiate claims against the estate for the recovery of Medicaid costs incurred during the individual’s lifetime.
What information must be reported on ESTATE RECOVERY PROGRAM NOTIFICATION OF DEATH?
The information that must be reported includes the deceased individual's full name, Social Security number, date of birth, date of death, and information regarding the Medicaid services received, along with the name and contact information of the person filing the notification.
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