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This version of the form is not currently in use and is provided for reference only. Download this version of
Instructions for Form DHS1100B
for the current year.
Instructions for Form DHS1100B Supplemental Form for Individuals Applying for Coverage on the Basis of Age, Blindness or Disability and / or Requests for Long-Term Care Services (Supplement to Form DHS 1100) - Hawaii
This document contains official instructions for Form DHS1100B , Supplemental Form for Individuals Applying for Coverage on the Basis of Age, Blindness or Disability and/or Requests for Long-Term Care Services (Supplement to Form DHS 1100) - a form released and collected by the Hawaii Department of Human Services. An up-to-date fillable Form DHS1100B is available for download through this link.
FAQ
Q: What is Form DHS1100B?
A: Form DHS1100B is a supplemental form for individuals applying for coverage based on age, blindness, disability, and/or long-term care services in Hawaii.
Q: Who should use Form DHS1100B?
A: Individuals who are applying for coverage on the basis of age, blindness, disability, and/or requesting long-term care services in Hawaii should use Form DHS1100B.
Q: What is the purpose of Form DHS1100B?
A: The purpose of Form DHS1100B is to provide additional information related to an individual's age, blindness, disability, and/or request for long-term care services to support their application for coverage in Hawaii.
Q: Is Form DHS1100B specific to Hawaii?
A: Yes, Form DHS1100B is specific to Hawaii as it is used for applying for coverage and requesting long-term care services in the state.
Q: Are there any other forms required along with Form DHS1100B?
A: Yes, Form DHS1100B is a supplement to Form DHS 1100, so both forms may be required to complete the application process.
Q: What information is needed on Form DHS1100B?
A: Form DHS1100B requires individuals to provide detailed information about their age, blindness, disability, and/or request for long-term care services, including relevant supporting documentation.
Q: Is assistance available for filling out Form DHS1100B?
A: Yes, if you need assistance with filling out Form DHS1100B, you can contact the Hawaii Department of Human Services for guidance and support.
Q: When should I submit Form DHS1100B?
A: Form DHS1100B should be submitted along with Form DHS 1100 as part of your application for coverage based on age, blindness, disability, and/or long-term care services in Hawaii.
Instruction Details:
- This 1-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Hawaii Department of Human Services.
