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This version of the form is not currently in use and is provided for reference only. Download this version of
Form MC010
for the current year.
Form MC010 Qualified Disabled Working Individual Information Notice - California
What Is Form MC010?
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of Form MC010?
A: The purpose of Form MC010 is to provide information about the Qualified Disabled Working Individual (QDWI) program in California.
Q: Who is eligible for the QDWI program?
A: To be eligible for the QDWI program, you must be disabled, working, and receiving Social Security Disability Insurance (SSDI).
Q: What benefits does the QDWI program provide?
A: The QDWI program provides payment of your Medicare Part A premium.
Q: How do I apply for the QDWI program?
A: You can apply for the QDWI program by completing and submitting Form MC010 to your local Social Security office.
Q: What happens after I submit a completed Form MC010?
A: After you submit a completed Form MC010, the Social Security office will review your application and notify you of your eligibility for the QDWI program.
Form Details:
- Released on May 1, 2007;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form MC010 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form MC010 Qualified Disabled Working Individual Information Notice - California
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