Get the free LDSS-4150 (12/08) - New York State Department of Health
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Medicaid Presumptive Eligibility for
Pregnant Individuals Screening YORK STATE DEPARTMENT OF HEALTH
Office of Health Insurance Programs
SECTION 1 APPLICANT INFORMATION
NameFirstHome Address
Confidential
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What is ldss-4150 1208 - new?
LDSS-4150 1208 - new is a form used by the New York State Office of Temporary and Disability Assistance to collect necessary information for public assistance benefits.
Who is required to file ldss-4150 1208 - new?
Individuals applying for or recertifying for public assistance benefits in New York State are required to file LDSS-4150 1208 - new.
How to fill out ldss-4150 1208 - new?
To fill out LDSS-4150 1208 - new, provide accurate personal information, income details, household composition, and any other required information as instructed on the form.
What is the purpose of ldss-4150 1208 - new?
The purpose of LDSS-4150 1208 - new is to gather necessary information from applicants to determine eligibility for public assistance programs.
What information must be reported on ldss-4150 1208 - new?
Information that must be reported includes personal details, income sources, family members, expenses, and other relevant financial information.
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