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This form is used by health care providers to submit information related to home health services as part of the Medicaid application process.
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How to fill out DHS 1139C (04/08)

01
Obtain the DHS 1139C (04/08) form from the appropriate government website or office.
02
Read the instructions provided on the form carefully.
03
Fill out the personal information section with your name, address, and contact details.
04
Provide any necessary identification information as requested.
05
Answer all relevant questions regarding your eligibility and the purpose of the application.
06
Double-check all entries for accuracy and completeness.
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Sign and date the form where indicated.
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Submit the completed form to the specified address or online portal.

Who needs DHS 1139C (04/08)?

01
Individuals applying for certain benefits or services related to the Department of Homeland Security.
02
Those who need to update their personal information or status with the DHS.
03
Applicants for specific programs or licenses that require DHS evaluation.
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DHS 1139C (04/08) is a form used by the Department of Homeland Security for reporting specific information related to immigration and citizenship.
Individuals or entities involved in certain immigration processes or petitions that require reporting to the Department of Homeland Security are required to file DHS 1139C (04/08).
To fill out DHS 1139C (04/08), follow the instructions provided on the form, ensuring to complete all necessary sections accurately, and submit it to the appropriate DHS office.
The purpose of DHS 1139C (04/08) is to gather necessary data related to immigration cases and to facilitate the processing of applications and petitions by the Department of Homeland Security.
The information that must be reported on DHS 1139C (04/08) includes personal details of the applicant, the nature of the immigration request, and any relevant supporting information required by the DHS.
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