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AUTHORIZATION TO DISCLOSE RECORDS OF: NAME LAST FIRST The following information may help in locating records: CLIENT IDENTIFICATION NUMBER MIDDLE DATE OF BIRTH FORMER NAMES OTHER IDENTIFICATION NUMBER

How to fill out dshs 17 063 form

How to fill out dshs 17 063:

1. Gather all necessary information and documents such as social security number, income information, and any supporting documentation that may be required.
2. Begin by carefully reading the instructions provided with the form. This will help you understand the purpose of the form and any specific requirements for filling it out.
3. Fill in your personal information accurately and legibly. This may include your name, address, contact information, and other relevant details.
4. Follow the guidelines provided on the form to complete the required sections. This may include providing information about your household members, income, expenses, and any other relevant details.
5. Double-check your entries to ensure accuracy and completeness. Mistakes or incomplete information may delay the processing of your application.
6. Sign and date the form where indicated. This confirms that the information provided is true and accurate to the best of your knowledge.
7. Attach any necessary documents or supporting information as instructed. Be sure to include all required documentation to avoid any delays or potential issues with your application.
8. Submit the completed form and any accompanying documents to the appropriate entity or agency. This may be an online submission, mailing address, or an in-person drop-off location.
9. Keep a copy of the filled-out form and any supporting documents for your records.

Who needs dshs 17 063:

1. Individuals who are applying for or receiving benefits from the Department of Social and Health Services (DSHS) or specific DSHS programs.
2. People who need to report changes in their personal circumstances or income to the DSHS.
3. Applicants or recipients of programs like cash assistance, food assistance, medical assistance, or other social services administered by DSHS.

For pdfFiller’s FAQs

What is dshs 17 063?

DSHS 17 063 is a form used by the Department of Social and Health Services to report financial information.

Who is required to file dshs 17 063?

Individuals or households receiving financial assistance from the Department of Social and Health Services may be required to file DSHS 17 063.

How to fill out dshs 17 063?

DSHS 17 063 can be filled out either online or by mail, providing information about income, expenses, and assets.

What is the purpose of dshs 17 063?

The purpose of DSHS 17 063 is to determine eligibility for financial assistance programs provided by the Department of Social and Health Services.

What information must be reported on dshs 17 063?

Information such as income, expenses, assets, and household members must be reported on DSHS 17 063.

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