MI DHS-4574 2011 free printable template

FOR OFFICE USE ONLY Grantee Name MEDICAID APPLICATION Patient of Nursing Facility State of Michigan Department of Human Services Grantee Client ID Case Number HELP IS AVAILABLE County District Section

How to fill out MI DHS-4574

How to fill out MI DHS-4574

1. Begin by downloading the MI DHS-4574 form from the Michigan Department of Health and Human Services website.
2. Fill out the applicant's name at the top of the form.
3. Provide the applicant’s address, including city, state, and ZIP code.
4. Enter the phone number and date of birth of the applicant.
5. Indicate the specific assistance or service being requested.
6. Complete any required demographic information, such as gender and ethnicity.
7. Review the form for accuracy and completeness.
8. Sign and date the application at the designated section.
9. Submit the completed form to the appropriate office or department as instructed.

Who needs MI DHS-4574?

1. Individuals seeking financial assistance or services from the Michigan Department of Health and Human Services may need MI DHS-4574.
2. Families applying for benefits related to food assistance, medical assistance, or other social services.

Instructions and Help about MI DHS-4574

People Also Ask about

Will Michigan Works help with car repairs?

AUTOMOBILE REPAIRS ($900/12-month time period) Automobile repairs may be authorized up to $900 per participant in any 12-month period. The vehicle must be his/her primary means of transportation for employment-related activities.

What does DHS do in Michigan?

Information on assistance with home repairs, heat and utility bills, relocation, home ownership, burials, home energy, and eligibility requirements. Information on the Food Assistance Program, eligibility requirements, and other food resources.

What is the road ready repairs program in Michigan?

Road Ready Repairs offers emergency car repair assistance grants of up to $800 for residents of either Wayne or Oakland County in Michigan.

What is the asset limit for Medicaid in Michigan?

The medically needy pathway also has an asset limit of $2,000 for an individual and $3,000 for a couple. 2) Asset Spend Down – Persons who have countable assets over Medicaid's limit can still become asset-eligible by spending down extra assets on non-countable ones.

Does Michigan DHS help with car repairs?

The total MDHHS/PATH program cost of repairs may not exceed $900 including any repairs done in the previous 12 months. Clients may contribute any amount over $900 prior to MDHHS payment. roadworthy including new tires, headlamps, batteries, etc.

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What is MI DHS-4574?

MI DHS-4574 is a form used by the Michigan Department of Health and Human Services (MDHHS) to report specific information related to eligibility for public assistance programs.

Who is required to file MI DHS-4574?

Individuals applying for or currently receiving public assistance benefits in Michigan are required to file MI DHS-4574 as part of their eligibility assessment.

How to fill out MI DHS-4574?

To fill out MI DHS-4574, individuals should provide accurate personal information, income details, household composition, and any other required data as specified in the form's instructions.

What is the purpose of MI DHS-4574?

The purpose of MI DHS-4574 is to collect information necessary for determining eligibility for various public assistance programs and to ensure compliance with state and federal regulations.

What information must be reported on MI DHS-4574?

The information reported on MI DHS-4574 must include personal identification, income sources and amounts, household members, and any changes in circumstances that may affect eligibility.