Form DHCS0011 Proof of Acceptable Citizenship or Identity Documents - California (Hmong)

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 Hmong. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DHCS0011 Proof of Acceptable Citizenship or Identity Documents?
A: DHCS0011 is a form required by the California Department of Health Care Services (DHCS) to provide proof of acceptable citizenship or identity documents.

Q: Who needs to fill out DHCS0011?
A: Any individual who is applying for or currently receiving health care benefits in California and needs to provide proof of their citizenship or identity needs to fill out DHCS0011.

Q: What is the purpose of DHCS0011?
A: The purpose of DHCS0011 is to verify the citizenship or identity of individuals applying for or receiving health care benefits in California.

Q: What documents can be used as proof of acceptable citizenship or identity?
A: Acceptable documents for proof of citizenship or identity include a U.S. passport, U.S. birth certificate, Certificate of Naturalization, Certificate of Citizenship, Permanent Resident Card, Employment Authorization Document, or valid foreign passport with visa and I-94 arrival/departure record.

Q: When do I need to submit DHCS0011?
A: DHCS0011 needs to be submitted when you apply for health care benefits in California or when requested by the DHCS for existing recipients.

Q: What happens if I don't submit DHCS0011?
A: Failure to submit DHCS0011 or provide acceptable proof of citizenship or identity may result in a denial of health care benefits or termination of existing benefits.

Q: Can I submit copies of my citizenship or identity documents?
A: Yes, you can submit copies of your citizenship or identity documents with DHCS0011. However, the copies must be clear, legible, and unaltered.

Q: Can I provide documents in Hmong language?
A: No, DHCS0011 requires that the documents be provided in English. If you have documents in another language, you may need to provide certified translations.

Q: Is DHCS0011 specific to the Hmong community?
A: No, DHCS0011 is not specific to the Hmong community. It is a general form used by the California DHCS for all individuals applying for or receiving health care benefits.