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Form MC176-2B QMB / SLMB / QI Qualified Medicare Beneficiary (Qmb) / Specified Low-Income Medicare Beneficiary (Slmb) / Qualifying Individual (Qi) Income Eligibility Work Sheet Child Applying With or Without Ineligible Parent(S) - California
What Is Form MC176-2B QMB/SLMB/QI?
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 Form MC176-2B?
A: Form MC176-2B is the Income Eligibility Work Sheet for QMB/SLMB/QI in California.
Q: What does QMB/SLMB/QI stand for?
A: QMB stands for Qualified Medicare Beneficiary, SLMB stands for Specified Low-Income Medicare Beneficiary, and QI stands for Qualifying Individual.
Q: Who is eligible to use Form MC176-2B?
A: This form is for individuals in California applying for QMB/SLMB/QI with or without ineligible parents.
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;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form MC176-2B QMB/SLMB/QI by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form MC176-2B QMB / SLMB / QI Qualified Medicare Beneficiary (Qmb) / Specified Low-Income Medicare Beneficiary (Slmb) / Qualifying Individual (Qi) Income Eligibility Work Sheet Child Applying With or Without Ineligible Parent(S) - California
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