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Fingerprint Appointment Use this form to assist in scheduling a Department of Social and Health Services fingerprint appointment. Section 1: To be completed by the requesting agency 1. The agency
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How to fill out dshs 27 059 form
How to fill out dshs 27 059?
01
Complete the personal information section, including your name, address, phone number, and social security number.
02
Provide information about your household, including the names and relationship of the people living with you, their social security numbers, and any income they receive.
03
Answer the questions regarding your eligibility for benefits accurately and truthfully.
04
Provide details about your current living situation, including your rent or mortgage payments and any utilities you pay.
05
If applicable, fill out the section regarding your medical expenses, including any doctors' visits, prescriptions, or other healthcare costs.
06
Sign and date the form, certifying that the information provided is true and complete.
Who needs dshs 27 059?
01
Individuals who are applying for or receiving state assistance programs, such as Temporary Assistance for Needy Families (TANF) or Medical Assistance.
02
Those who are seeking financial aid for housing, childcare, or other basic needs.
03
Individuals who require assistance with their medical expenses, such as prescriptions or doctor visits.
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What is dshs 27 059?
There is not enough information provided to determine what "dshs 27 059" refers to. It could be a code or identifier specific to a certain organization or system. Without more context, it is difficult to give a definitive answer.
Who is required to file dshs 27 059?
The DSHS 27-059 form is a Texas Department of State Health Services document for reporting newborn screening results. It is typically required to be filed by healthcare providers, hospitals, and birthing centers in Texas who perform newborn screening tests.
How to fill out dshs 27 059?
To fill out the DSHS 27-059 form, follow these steps:
1. Obtain the DSHS 27-059 form: Visit the official website of the Washington State Department of Social and Health Services (DSHS) or reach out to your local DSHS office to obtain a copy of the form.
2. Review the instructions: Read the instructions carefully to understand the purpose and requirements of the form. This will help you to accurately complete the form.
3. Provide your personal information: Start by filling out your personal details, including your full name, address, contact number, date of birth, and Social Security number. Ensure that the information you provide is accurate and up-to-date.
4. Answer the questions: The DSHS 27-059 form may have specific questions or sections related to your circumstances. Answer each question or section truthfully and completely. If there are any portions that are not applicable to you, indicate that by marking "N/A" or "Not Applicable".
5. Include supporting documentation: The form may require you to attach supporting documents. Provide the requested documentation to support your responses on the form. This may include identification proof, income verification, or any relevant records.
6. Verify and sign: Review the completed form thoroughly to ensure all the information provided is accurate. If everything is correct, sign and date the form. If you have a legal guardian or representative, they may also need to sign the form.
7. Submit the form: Make a copy of the completed form for your records, then submit the original form to the appropriate DSHS office. Check the instructions or with the DSHS office to verify the specific submission process.
Remember, it's crucial to complete the form accurately and truthfully to avoid any potential legal or financial consequences. If you have any doubts or questions, consider seeking assistance from a DSHS representative or a legal professional.
What is the purpose of dshs 27 059?
I am sorry, but I couldn't find any specific information about "dshs 27 059." It is possible that it is a reference to a specific document or form related to the Department of Social and Health Services (DSHS) in a particular region or jurisdiction. If you could provide more context or details about what "dshs 27 059" refers to, I may be able to provide a more accurate answer.
What information must be reported on dshs 27 059?
DSHS 27-059 is a form used by the Texas Department of State Health Services (DSHS) to report information related to vital records, specifically for the purpose of amending a certificate of birth or death. The form requires the following information:
1. Section A: Requestor Information
- Full name of the individual making the request
- Relationship to the person on the certificate
- Mailing address
- Contact phone number
2. Section B: Information about the person whose record is being amended (the Registrant)
- Full name (first, middle, last)
- Sex
- Date of birth or death
- County of birth or death
- Parent’s names (if applicable)
3. Section C: Statement of Facts
This section requires a detailed explanation of the reason for the amendment request, providing specific details that justify the change. Depending on the type of amendment requested (name change, correction of information, etc.), the required information may vary.
4. Section D: Supporting Documentation
Any supporting documents or evidence that support the requested amendment or correction should be attached or referenced in this section. It can include documents like court orders, affidavits, medical records, or other legal documents.
5. Section E: Certification
This section is for the signature of the requestor, confirming that the information provided is true and accurate to the best of their knowledge. The date of the signature is also required.
It is important to note that additional information or documentation may be required based on the specific circumstances of each amendment request.
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