AL Form 471 2024-2026 free printable template

Alabama Medicaid Agency Prior Authorization (PA) Change Request Supplier Information Contact Name: NPI: Phone Number:Recipient Information Recipient Name: Medicaid ID:Prior Authorization Number Reason

How to fill out AL Form 471

How to fill out AL Form 471

1. Gather necessary information about your organization, including contact details and EIN.
2. Identify the type of service you are applying for (telecommunications, internet access, etc.).
3. Fill out Section 1: Basic Information, ensuring all fields are accurate.
4. Complete Section 2: Discount Calculation, based on eligible services and your student population.
5. Provide detailed descriptions of the services and their costs in Section 3.
6. Sign and date the form as required.
7. Review all entries for accuracy and completeness before submission.
8. Submit the form through the appropriate channels by the deadline.

Who needs AL Form 471?

1. Organizations such as schools, libraries, and non-profits seeking E-Rate funding for eligible telecommunications and internet services.

People Also Ask about

What is the asset limit for Medicaid in Alabama?

Excess Resources This means that in order to be eligible for Medicaid you must not have more than $2,000 in resources on the first day of any given month. To keep from going over the $2,000 limit: If you owe money to the nursing home, pay it before the first of the month.

What is the lookback period for Medicaid in Alabama?

In Alabama, that period of time is 60 months (5 years). This 60 month period of time is commonly known as the medicaid lookback period. Any gifts or transfers of assets for less than market value made during the lookback period may result in a transfer penalty.

What assets are exempt from Medicaid in Alabama?

Other exemptions include personal belongings, such as clothing, household furnishings, an automobile, and generally one's primary home. For home exemption, the Medicaid applicant must live in their home or have Intent to Return, and in 2023, their home equity interest must be no more than $688,000.

How much can you make and still get Medicaid in Alabama?

Who is eligible for Alabama Medicaid? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows

What is the income guidelines for Al Medicaid?

QI-1 or Qualified Individual (effective February 2023): Income cannot exceed $1,661 per month for an individual. Income cannot exceed $2,239 per month for a couple.

What is the income limit for Medicaid waiver in Alabama?

Financial Eligibility: The income limit is $2,742 per month. The resource limit is $2,000 as of the first day of each month. Level of Care: The individual must be disabled and meet the nursing facility level of care.

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What is AL Form 471?

AL Form 471 is a document used to report certain financial information related to a specific regulatory or tax purpose in the state of Alabama.

Who is required to file AL Form 471?

Entities or individuals that fall under the required reporting criteria set by the state of Alabama, typically including businesses and organizations that engage in certain activities subject to regulation.

How to fill out AL Form 471?

To fill out AL Form 471, you need to provide accurate financial and operational information as specified in the form instructions, ensuring all required fields are completed and calculations are accurate.

What is the purpose of AL Form 471?

The purpose of AL Form 471 is to ensure compliance with state regulations by collecting necessary financial data that aids in the oversight of businesses and organizations operating in Alabama.

What information must be reported on AL Form 471?

The information required on AL Form 471 typically includes financial statements, income details, expenditure reports, and any other relevant data as specified in the form's accompanying guidelines.