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OMB No. 09381378 Expires: 7/31/20242024 Medicare Advantage Prescription Drug PlanIndividual Enrollment Request Form
Who can use this form? People with Medicare who want to join a
Medicare Advantage
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What is lawfully present in form?
The lawfully present in form is a document used to verify an individual's lawful presence in the United States, often required for certain applications or benefits.
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Individuals applying for specific state benefits or services that require verification of lawful presence must file the lawfully present in form.
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To fill out the lawfully present in form, you generally need to provide personal information such as your name, date of birth, immigration status, and any relevant identification numbers.
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The purpose of the lawfully present in form is to confirm an individual's lawful status to ensure compliance with federal and state regulations regarding benefits and services.
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The information required typically includes full name, address, the immigration status of the individual, government-issued identification numbers, and any other pertinent details as specified by the issuing authority.
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