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Form Approved OMB No. 0938-1191 Application for Health Coverage & Help To pay Costs (Short Form) THINGS TO KNOW Who can use this application? Use this application to see what coverage you qualify
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Start by gathering all the necessary documents and information needed to complete the application. This includes personal identification, employment history, and any relevant certifications or qualifications.
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Carefully read through and understand the instructions provided on the application. Make sure you have a clear understanding of what is being asked and the format in which you need to provide your responses.
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Begin filling out the application by entering your personal information such as your full name, address, phone number, and email address. Double-check for accuracy before proceeding.
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Move on to the sections that require your employment history. Provide details about your previous job positions, including the names of the companies, job titles, dates of employment, and a brief description of your responsibilities.
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If the application asks for any educational background, provide information about your qualifications, including the schools attended, degrees obtained, and any relevant coursework or certifications.
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Who needs ez application - select?

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Individuals who are seeking employment opportunities and need an easy-to-use application form.
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EZ application - select is a simplified online application process for certain programs or services.
Individuals or businesses meeting certain criteria specified by the program or service may be required to file EZ application - select.
EZ application - select can be filled out online by providing the required information and following the step-by-step instructions.
The purpose of EZ application - select is to streamline the application process and make it easier for individuals or businesses to apply for the program or service.
The information required on EZ application - select may vary depending on the program or service, but typically includes personal or business details, financial information, and eligibility criteria.
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