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State of CaliforniaHealth and Human Services AgencyDepartment of Health Care Services JENNIFER KENTDirectorEDMUND G. BROWN JR. Governor February 3, 2017MediCal Eligibility Division Information Letter

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What is i 17-05?

i 17-05 is a form used for reporting certain information to the relevant authorities.

Who is required to file i 17-05?

Individuals or entities meeting specific criteria are required to file i 17-05.

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To fill out i 17-05, you need to provide the requested information in the designated fields on the form.

What is the purpose of i 17-05?

The purpose of i 17-05 is to collect and report specific data for regulatory or compliance purposes.

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