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Get the PA 600 L 2006

Dist Worker I. D. Record Number File Cleared by Appl. Reg. No. Caseload Authorized Reason Category Not Authorized Reason Date PA 600 L SG 8/06 Page 1 Please Complete the Following Information for the Person Requesting Medical Assistance Benefits Last Name First Name Current Address If in a facility use facility address Date Moved To This Address Township Middle Initial Jr. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE MEDICAL ASSISTANCE MEDICAID FINANCIAL ELIGIBILITY APPLICATION...
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Who needs a PA form 600 L?

Form 600 is an application for medical assistance benefits. It was designed for residents of Pennsylvania. It doesn’t matter if the applicant himself fills out this form. He can also have someone do it on his behalf. If a spouse, attorney, or close friend has the necessary information, they can fill out this form.

What is a PA form 600 L for?

The applicant uses this form to prove his financial eligibility to the county assistance office, where the decision on the application is made.

Is it accompanied by other forms?

It doesn’t require any addenda, although the county assistance office may require some receipts or personal statements from your bank or medical provider to prove the information contained in your application. Sometimes they ask the applicant to bring these documents to a face-to-face interview. In some cases they already have all necessary medical records to make their decision.

When is PA form 600 L due?

There is no due date for this application. You can file it whenever you decided to apply for medical assistance benefits. The county assistance officer will contact you within 30 days after your application has been received.

How do I fill out a PM form 600 L?

There are 11 pages in this document. The first and the last pages contain instructions and warnings for applicants concerning the possibility of refusal and issues of records disclosure. Be sure you have backup documents for all your statements. Fill out every page carefully. If you follow instructions and provide complete information, you can send the application and get ready for the interview.

Where do I send it?

Bring it or mail it to the closest county assistance office. You can find the closest office in this table.

Please select a version for Fillable PA 600 L form
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Please select a version for Fillable PA 600 L form
  • 2012 PA 600 L Fillable
  • 2011 PA 600 L Fillable
  • 2009 PA 600 L Fillable
  • 2006 PA 600 L Fillable
  • More...