Form MC176 S Medi-Cal Status Report - California (Cambodian)

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.

The document is provided in Cambodian. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form MC176 S?
A: Form MC176 S is a Medi-Cal Status Report in California.

Q: Who is Form MC176 S for?
A: Form MC176 S is for Medi-Cal beneficiaries in California who speak Cambodian.

Q: What is the purpose of Form MC176 S?
A: The purpose of Form MC176 S is to report any changes in Medi-Cal status for Cambodian-speaking beneficiaries in California.

Q: How can I obtain Form MC176 S?
A: You can obtain Form MC176 S by contacting your local Medi-Cal office in California.

Q: What information is required on Form MC176 S?
A: Form MC176 S requires information such as the beneficiary's name, address, Social Security Number, and details of any changes in income, household composition, or other relevant information.

Q: When should I submit Form MC176 S?
A: You should submit Form MC176 S within 10 days of any changes in your Medi-Cal status or personal information.

Q: Are there any penalties for not submitting Form MC176 S?
A: Failure to submit Form MC176 S or providing false information may result in loss of Medi-Cal benefits or legal consequences.