Get the free Title IV-E/Medicaid Information Form for Foster Child
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DHS/CFS Form 61FC 1/2014 Title FIVE/Medicaid Information Form for Foster Child Received Date: Child in Custody Information Name of Child (last, first, middle) Social Security Number Current Placement
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What is title iv-emedicaid information form?
Title IV-eMedicaid information form is a document used to report Medicaid information for Title IV-e eligible children in foster care.
Who is required to file title iv-emedicaid information form?
Foster parents or legal guardians of Title IV-e eligible children are required to file the form.
How to fill out title iv-emedicaid information form?
The form can be filled out electronically or manually by providing the necessary Medicaid information for the eligible child in foster care.
What is the purpose of title iv-emedicaid information form?
The purpose of the form is to ensure that Title IV-e eligible children in foster care receive the appropriate Medicaid benefits.
What information must be reported on title iv-emedicaid information form?
The form requires information such as the child's Medicaid ID, eligibility status, and any changes in Medicaid coverage.
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