WebVisit SCDHHS.gov or call us at 1-888-549-0820. Para obtener una copia de este formulario en Espaol, llame 1-888-549-0820. ... please request a DHHS Form 3400, Application for … WebThe SCDHHS PRTF Waiver Project Director will then fax the DHHS Form 118-B to the local eligibility office at 803-741-9475. The local eligibility office will complete a DHHS Form 1233 ME; and send to the beneficiary requesting the DHHS Form 3400, DHHS Form 3400-B, and other information necessary to complete a look-back.

FORMS - SC DHHS

http://www1.scdhhs.gov/internet/eligfm/FM3400-01.pdf WebDHHS Form 3400-C - euest for etroactive Coverae (une 201) Person 1 1.First name, Middle name, Last name, & Suffix 2.Date of birth (mm/dd/yyyy) ... SCDHHS - Central Mail PO Box … bob\u0027s stores check gift card balance

Dhhs form 3400 b: Fill out & sign online DocHub

WebSee DHHS Form 3400 (Application for Medicaid and Affordable Health Coverage) for more information ... SCDHHS does not exclude people or treat them differently because of race, … WebTo Apply to this Group Use Form: 3400 Healthy Connections Application 3400-A Additional Information for Select Medicaid Programs. ... If you have questions about this form, call … WebEdit your scdhhs form 3400 b june 2016 online. Type text, add images, blackout confidential details, add comments, highlights and more. 02. ... Get the Dhhs form 3400 b completed. Download your modified document, export it to the cloud, print it from the editor, ... cll and dental work