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Dhs 1004 Form

Dhs 1004 Form

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What is the DHS 1004 Form?

The DHS 1004 form, also known as the Michigan Department of Health and Human Services (MDHHS) form, is primarily used for the purpose of applying for public assistance programs in the state of Michigan. This form collects essential information about the applicant's household, income, and other relevant factors that determine eligibility for various state assistance programs. Understanding the purpose of this form is crucial for individuals seeking help from state resources.

How to Obtain the DHS 1004 Form

The DHS 1004 form can be obtained through several methods to ensure accessibility for all applicants. Individuals can visit their local MDHHS office to request a physical copy of the form. Additionally, the form is available online through the official MDHHS website, where applicants can download and print it. This flexibility allows users to choose the method that best suits their needs.

Steps to Complete the DHS 1004 Form

Completing the DHS 1004 form requires careful attention to detail. Applicants should follow these steps:

  • Begin by gathering necessary documentation, such as proof of income, identification, and household information.
  • Fill out personal information, including name, address, and contact details.
  • Provide information about household members, including their ages and relationships.
  • Detail income sources and amounts for all household members.
  • Review the completed form for accuracy before submission.

Key Elements of the DHS 1004 Form

The DHS 1004 form includes several key elements that are critical for the application process. These elements typically consist of:

  • Personal identification details of the applicant.
  • Information about all household members.
  • Income verification, including pay stubs or tax returns.
  • Details regarding any assets owned by the household.
  • Signature and date to confirm the information provided is accurate.

Form Submission Methods

Once the DHS 1004 form is completed, applicants have multiple submission methods available. The form can be submitted in person at a local MDHHS office, ensuring that staff can assist with any questions. Alternatively, it can be mailed to the appropriate MDHHS office address. Some applicants may also have the option to submit the form electronically, depending on the specific program requirements.

Legal Use of the DHS 1004 Form

The DHS 1004 form is legally binding, meaning that the information provided must be truthful and accurate. Submitting false information can lead to penalties, including disqualification from assistance programs. It is essential for applicants to understand their rights and responsibilities when filling out this form, ensuring compliance with state regulations.

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