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State of California Health and Human Services Agency Department of Developmental Services MEDICAID WAIVER ELIGIBILITY RECORD Reset Form DS 3770 Rev. 10/2016 Consumer Name Eligible Birthdate Termination Date Reactivation UCI Recertification ALL LEVEL OF CARE QUALIFYING DEFICITS Includes special health care requirements Short Term Absences Specify dates Yes No Comments if needed Signature and Title QIDP Confidential Client Information W I Code Sections 4514 and 5328.
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What is ds 3770?
DS-3770 is a form used for reporting foreign financial assets to the IRS.
Who is required to file ds 3770?
U.S. taxpayers who meet certain thresholds for foreign financial assets are required to file the DS-3770 form.
How to fill out ds 3770?
DS-3770 can be filled out electronically using the IRS e-File system or by mailing a paper copy to the designated address. It is important to follow the instructions provided by the IRS when filling out the form.
What is the purpose of ds 3770?
The purpose of DS-3770 is to provide the IRS with information about foreign financial assets held by U.S. taxpayers, in order to detect and deter tax evasion.
What information must be reported on ds 3770?
DS-3770 requires taxpayers to report various details about their foreign financial assets, including their nature, value, and income generated.
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