Formulario DOH-5247ES Medicaid Authorized Representative Designation / Change Request - New York (Spanish)

Qué es Formulario DOH-5247ES?

Este es un formulario legal que fue publicado por el New York State Department of Health, una autoridad gubernamental que opera dentro de New York. A partir de hoy, el departamento emisor no proporciona en separado pautas de presentación para el formulario.

Detalles del formulario:

• Publicado el 1 de noviembre de 2017;
• La última versión proporcionada por el New York State Department of Health;
• Lista para utilizar e imprimir;
• Fácil de personalizar;
• Compatible con la mayoría de las aplicaciones para visualizar PDF;
• Complete este formulario en línea.

Descargue una versión del Formulario DOH-5247ES haciendo clic en el enlace debajo o busque más documentos y plantillas proporcionados por el New York State Department of Health.

FAQ

Q: What is the DOH-5247ES form?
A: The DOH-5247ES form is a Medicaid Authorized Representative Designation/Change Request form.

Q: What is the purpose of the DOH-5247ES form?
A: The DOH-5247ES form is used to designate or change an authorized representative for Medicaid in New York.

Q: Who can use the DOH-5247ES form?
A: Any individual who is applying for or receiving Medicaid benefits in New York can use the DOH-5247ES form to designate or change an authorized representative.

Q: Is the DOH-5247ES form available in Spanish?
A: Yes, the DOH-5247ES form is available in Spanish.

Q: Do I need to submit the DOH-5247ES form if I already have an authorized representative?
A: No, you only need to submit the DOH-5247ES form if you want to designate a new authorized representative or change an existing one.

Q: What information do I need to provide on the DOH-5247ES form?
A: You will need to provide your personal information, including your name, address, Medicaid case number, and the information of the designated authorized representative.

Q: Can I designate more than one authorized representative?
A: Yes, you can designate multiple authorized representatives on the DOH-5247ES form.

Q: How long does it take to process the DOH-5247ES form?
A: The processing time for the DOH-5247ES form may vary, but it usually takes around 30 days.

Q: Is there a fee for submitting the DOH-5247ES form?
A: No, there is no fee for submitting the DOH-5247ES form.