Get the free HCBS EligibilityIneligibilityChange Form - dpw state pa

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HOME AND COMMUNITY BASED SERVICES (HUBS) ELIGIBILITY/INELIGIBILITY/CHANGE FORM (Completion Instructions on Pages 47) County assistance office (CAN) name: DEPARTMENT OF HUMAN SERVICES (DHS) OFFICE

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What is hcbs eligibilityineligibilitychange form?

The HCBS eligibility/ineligibility/change form is a document used to update information regarding an individual's eligibility for Home and Community-Based Services.

Who is required to file hcbs eligibilityineligibilitychange form?

The form must be filed by individuals who are receiving or applying for Home and Community-Based Services.

How to fill out hcbs eligibilityineligibilitychange form?

To fill out the form, individuals need to provide accurate information about their eligibility status and any changes that may have occurred.

What is the purpose of hcbs eligibilityineligibilitychange form?

The purpose of the form is to ensure that individuals receiving Home and Community-Based Services have up-to-date eligibility information.

What information must be reported on hcbs eligibilityineligibilitychange form?

The form requires individuals to report any changes in their living situation, income, or health that may affect their eligibility for services.

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