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Your Texas Benefits

Medicaid Buy-In for Children is a different program. It is for families who have a child with a disability, but make too much money to get traditional Medicaid. To get the form for that program, call 2-1-1 or 1-877-541-7905 and ask for Form H1200-MBIC. Medicare Savings Programs Helps people who already get Medicare. Helps people pay Medicare costs.

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Application for Prior Medicaid Coverage - Your …

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Form H1113 December 2016 Application for Prior Medicaid Coverage You might be eligible for Medicaid for three months before the month you applied for Medicaid.

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Items we might need from anyone on your case

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More items we might need from you If you need help getting these items, let us know. It’s our duty to help you. Don’t send this form back to us.

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Your Texas Benefits: Getting Started

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Questions about this form or about benefits • Go to YourTexasBenefits.com. or • Call 2-1-1 (if you can’t connect, call 1-877-541-7905). After you pick a …

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Texas Department of Human Services - Your Texas Benefits

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Texas Health and Human Services Commission Medical Release/Physician’s Statement Form H1836-A January 2006 Section I — To Be Completed By Staff Name of Patient Date of Birth Social Security No. - - Case Name (caregiver) Case No. Patient’s Usual Job

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Your Texas Benefits: Getting Started

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Call 2-1-1 to find a Texas Workforce Center. Family Violence Program . Are you afraid for your children’s or your safety? You can get help: • Getting a ride to a safe place. • Finding shelter, legal help, and a job. • Getting counseling. Call the hotline anytime at 1-800-799-7233 (1-800-799-SAFE). Adult Education and Family Literacy Program

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North Carolina Department of Health and Human Services ...

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Step 1. Fill out this application: You have the right to receive an application upon request. If you cannot complete this application you will only need to provide a signature, legible name, and address. If you need assistance in completing this form, please let …

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SS-4 Application for Employer Identification Number

www.irs.gov

want to file Form 944 annually instead of Forms 941 quarterly, check here. (Your employment tax liability generally will be $1,000 or less if you expect to pay $5,000 or less in total wages.) If you don’t check this box, you must file Form 941 for every quarter. 15 . First date wages or annuities were paid (month, day, year). Note:

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Tennessee Department of Human Services Please tell us if ...

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Tennessee Department of Human Services Please tell us if you need assistance with this form because you have a disability or Family Assistance Application don’t speak English. Free assistance is available. Contact the Family Assistance Service Center Number 866-311-4287 and/or the TTY number at 711. If you have a

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