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State of California Health and Human Services AgencyDepartment of Health Care Services Counselor & Medication Assisted Treatment Section, MS 2603 PO Box 997413 Sacramento, CA 958997413APPLICATION
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How to fill out dhcs 5135 application for

01
To fill out the DHCS 5135 application form, follow these steps:
02
Download the DHCS 5135 application form from the official DHCS website.
03
Read the instructions carefully before you begin filling out the form.
04
Gather all the required information and documents such as personal identification, income details, and any supporting documents required for the application.
05
Start by providing your personal information such as name, date of birth, and contact information in the specified sections of the form.
06
Proceed to fill out the sections related to your household information, including the number of people in your household and their relationships.
07
Provide accurate details about your income, including any wages, benefits, or other sources of income for everyone in your household.
08
If applicable, complete the sections regarding your healthcare coverage, including any current insurance plans or programs you are enrolled in.
09
Once you have completed all the necessary sections, review the form to ensure all information is accurate and complete.
10
Sign and date the application form at the designated area.
11
Make a copy of the completed application for your records and submit the original form to the designated DHCS office or mail it to the specified address as mentioned in the instructions.
12
Keep track of your application status and follow up as necessary with the DHCS office.
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Remember to keep copies of all supporting documents and communications related to your application for future reference.

Who needs dhcs 5135 application for?

01
The DHCS 5135 application form is needed by individuals and families who are seeking to apply for health coverage programs offered by the California Department of Health Care Services (DHCS).
02
This application form is specifically used to determine eligibility for programs such as Medi-Cal, California Children's Services (CCS), Genetically Handicapped Persons Program (GHPP), and other similar healthcare coverage programs in California.
03
Whether you are an adult, a parent/caretaker, a pregnant woman, or a child under the age of 21, if you meet certain income and eligibility criteria, you may need to fill out the DHCS 5135 application form to apply for these programs and receive necessary healthcare services and support.
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The dhcs 5135 application is for Medi-Cal benefits.
Individuals seeking Medi-Cal benefits are required to file the dhcs 5135 application.
The dhcs 5135 application can be filled out online on the Medi-Cal website or in person at a local Medi-Cal office. It requires personal information, income verification, and other relevant documents.
The purpose of the dhcs 5135 application is to determine eligibility for Medi-Cal benefits.
The dhcs 5135 application requires information such as personal details, income, household size, assets, and medical expenses.
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