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Eligibility Review furlong Term Services and Supports Client Name (first, middle initial, last)Client ID NumberClient Address City State Zip Comeliest Mailing Address City State Zip Comeliest Phone
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How to fill out dshs 14 416

01
To fill out DSHS 14 416, follow these steps:
02
Start by downloading the DSHS 14 416 form from the official website of the Department of Social and Health Services (DSHS).
03
Read the instructions carefully to understand the purpose of the form and the information required.
04
Gather all the necessary documents and information needed to complete the form, such as personal details, income information, and any supporting documents.
05
Begin filling out the form by entering your personal information, such as your full name, address, date of birth, and contact details.
06
Provide accurate and complete information about your household members, including their names, ages, relationship to you, and any public assistance received.
07
Fill in the sections related to income, assets, and expenses. Include details about your employment, any government benefits, and other sources of income.
08
If applicable, provide details about your housing situation, such as rent or mortgage payments, utility bills, and any other related expenses.
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Make sure to review the completed form for accuracy and completeness. Double-check all the information provided and make any necessary corrections.
10
Sign and date the form at the designated space to certify the accuracy of the information provided.
11
Submit the filled-out DSHS 14 416 form to the appropriate DSHS office by mail or in person as per the instructions provided.

Who needs dshs 14 416?

01
The DSHS 14 416 form is needed by individuals who are applying for or receiving assistance programs offered by the Department of Social and Health Services (DSHS). This form helps DSHS determine eligibility for various programs, such as Temporary Assistance for Needy Families (TANF), Medical Assistance, and Supplemental Nutrition Assistance Program (SNAP). It is typically required for applicants or recipients who need to report changes in their circumstances or provide updated information for the continuation of benefits.

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DSHS 14 416 is a form used by the Washington State Department of Social and Health Services for reporting information related to specific services or programs.
Individuals or entities that provide certain services or programs governed by the Washington State Department of Social and Health Services may be required to file DSHS 14 416.
To fill out DSHS 14 416, one must enter the required information accurately in the designated fields, ensuring to follow any specific instructions provided with the form.
The purpose of DSHS 14 416 is to ensure accurate reporting of data required by the Department of Social and Health Services for program evaluation and compliance.
Information reported on DSHS 14 416 typically includes details about the program or service provided, participant information, dates of service, and other relevant data.
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