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Form DHAS-39 Health Insurance Information - New Jersey
What Is Form DHAS-39?
This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DHAS-39?
A: Form DHAS-39 is a health insurance information form used in New Jersey.
Q: Who needs to fill out Form DHAS-39?
A: Individuals in New Jersey who are applying for or receiving public assistance, including Medicaid, are required to fill out Form DHAS-39.
Q: What information is required on Form DHAS-39?
A: Form DHAS-39 requires information about the individual's health insurance coverage, including the name of the insurance company, policy number, and coverage dates.
Q: When should I submit Form DHAS-39?
A: Form DHAS-39 should be submitted when applying for or renewing public assistance in New Jersey.
Q: Is Form DHAS-39 confidential?
A: Yes, the information provided on Form DHAS-39 is confidential and protected by law.
Form Details:
- Released on March 1, 2014;
- The latest edition provided by the New Jersey Department of Health;
- 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 DHAS-39 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.
