AL Form 357 2015-2026 free printable template

If you have questions please call Medicaid at 1-800-362-1504. The call is free. Form 357 7/2015 Alabama Medicaid Agency Plan First Application Form 357 Please print and use dark ink. A Family Planning Program Females Ages 19-55 Males Ages 21 and older for Vasectomies only Application for the Medicaid Plan First Program This application is for family planning birth control services only for females 19-55 years of age and males 21 and over. Signature Date Name and phone number of person helping...

How to fill out AL Form 357

How to fill out AL Form 357

1. Obtain a copy of AL Form 357 from the relevant authority or website.
2. Fill in your personal details, including name, address, and contact information in the designated fields.
3. Provide the date of the incident or issue that prompted the need for the form.
4. Describe the circumstances surrounding your situation clearly and concisely in the explanation section.
5. Attach any required documentation or evidence to support your claims.
6. Review the form for accuracy and completeness.
7. Sign and date the form at the bottom before submission.
8. Submit the completed form to the appropriate department or office as instructed.

Who needs AL Form 357?

1. Individuals or businesses who need to report an incident or request assistance related to a specific matter covered by AL Form 357.

People Also Ask about

What does Alabama family planning Medicaid cover?

Eligible women qualify for most family planning services and supplies, including birth control pills, the Depo-Provera shot, vaginal ring, diaphragm and contraceptive patch, doctor/clinic visits (for family planning only) and tubal ligations.

What is covered by Medicaid in Alabama?

Medicaid patients get medical care from a variety of sources. Covered medical services include dental, eye and hearing care, lab and x-ray services as well as renal dialysis and transplant coverage.Learn More: Covered Services. Medical Services. Pharmacy/DME Services. Medical Facilities. Transportation. ACHN.

Does Medicaid pay for vasectomy in Alabama?

Men age 21 or older may qualify for vasectomies only. For women, this includes a yearly family planning exam, birth control such as pills or shots, tubes tied, lab work to test for pregnancy or sexually-transmitted disease and help in planning when to have a baby. Call 1-888-737-2083 toll-free for more information.

What is the income limit for pregnancy Medicaid in Alabama?

Plan First/Pregnant Women/Children (Ages 0-18):* Income after deductions cannot exceed $1,774 per month for a family of 1. Income after deductions cannot exceed $2,400 per month for a family of 2. Income after deductions cannot exceed $3,025 per month for a family of 3.

How long does it take to get approved for Medicaid in Alabama?

It usually takes about 45 days to process an application once all information is received by the Medicaid worker (when the application is complete). If I qualify, how will that work? If you qualify for the QI-1 program, Medicaid will tell Social Security to stop deducting this money from your Social Security check.

Does Medicaid cover vasectomy in Alabama?

Plan First Program Eligible men qualify for doctor/clinic visits (for family planning only), vasectomies and post semen analysis.

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What is AL Form 357?

AL Form 357 is a form used for reporting the change of address for individuals and businesses in the state of Alabama.

Who is required to file AL Form 357?

Individuals and businesses who have changed their mailing address in Alabama are required to file AL Form 357 to ensure that their information is updated in state records.

How to fill out AL Form 357?

To fill out AL Form 357, provide accurate personal or business information, including the previous and new mailing addresses, and any relevant identification numbers. Sign and date the form before submitting it.

What is the purpose of AL Form 357?

The purpose of AL Form 357 is to notify the state of Alabama about changes in addresses, which helps maintain accurate records and ensures that individuals and businesses receive important correspondence.

What information must be reported on AL Form 357?

The information that must be reported on AL Form 357 includes the person's or business's name, previous address, new address, date of address change, and any identification numbers if applicable.