AK DHSS GEN 50C (06-3860) 2022-2025 free printable template
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State of Alaska Department of Health and Social Services Division of Public Assistance http://dhss.alaska.gov/dpa/ Application for Services If you need help filling out this form or have questions,
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How to fill out AK DHSS GEN 50C (06-3860)
01
Obtain the AK DHSS GEN 50C (06-3860) form from the Alaska Department of Health and Social Services website or office.
02
Read the instructions carefully to understand the information required.
03
Fill in your full name in the designated section at the top of the form.
04
Provide your current address, including city, state, and zip code.
05
Enter your date of birth in the specified format.
06
Specify your social security number as requested.
07
Indicate the type of assistance you are applying for by checking the appropriate boxes.
08
Provide the names and addresses of any other household members who will be included in the application.
09
Attach any required documentation as indicated in the instructions.
10
Review the completed form for accuracy and completeness.
11
Sign and date the form before submission.
Who needs AK DHSS GEN 50C (06-3860)?
01
Individuals applying for assistance programs through the Alaska Department of Health and Social Services.
02
Families with low income seeking support services from the state.
03
Applicants needing to report changes in their circumstances to maintain eligibility for assistance.
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People Also Ask about
How do I find my Alaska Medicaid number?
Please call Conduent at (907) 644-6800 or our in-state toll free number, (800) 770-5650, about your participation in Alaska Medical Assistance.
How do I contact Medicaid in Alaska?
If you are located in the Anchorage area call 907-644-6800. If you are located outside the Anchorage area or in another state, you may call toll free at 800-770-5650.
What is the Alaska State Assistance Program?
The Alaska Temporary Assistance Program ( ATAP ) provides cash assistance and work services to low-income families with children to help them with basic needs while they work toward becoming self-sufficient. This program is provided under the federal Temporary Assistance for Needy Families ( TANF ) block grant.
Who is the director of the Alaska DPA?
Department of Health Communications Director Clinton Bennett said in an email that Deb Etheridge, a former health department employee, will take up the position.
How do I report a change to Medicaid in Alaska?
You may also contact Public Assistance at 800-478-7778 to get this information. Changes must be reported within 10 days of when you know of the change.
What is the welfare system in Alaska?
The Alaska Temporary Assistance Program ( ATAP ) provides cash assistance and work services to low-income families with children to help them with basic needs while they work toward becoming self-sufficient. This program is provided under the federal Temporary Assistance for Needy Families ( TANF ) block grant.
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What is AK DHSS GEN 50C (06-3860)?
AK DHSS GEN 50C (06-3860) is a form used by the Alaska Department of Health and Social Services for reporting certain health-related information and data.
Who is required to file AK DHSS GEN 50C (06-3860)?
Entities and individuals who are required to report health-related data as per state regulations need to file AK DHSS GEN 50C (06-3860).
How to fill out AK DHSS GEN 50C (06-3860)?
To fill out AK DHSS GEN 50C (06-3860), provide accurate information as requested in each section of the form, ensuring all required fields are completed and any necessary signatures are included.
What is the purpose of AK DHSS GEN 50C (06-3860)?
The purpose of AK DHSS GEN 50C (06-3860) is to collect and report health data to assist in public health planning, monitoring, and evaluation within the state.
What information must be reported on AK DHSS GEN 50C (06-3860)?
The information that must be reported on AK DHSS GEN 50C (06-3860) includes demographics, health conditions, treatments, and any other relevant data as specified in the form instructions.
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