Form DOH-5247IT Medicaid Authorized Representative Designation / Change Request - New York (Italian)

This is a legal form that was released by the New York State Department of Health - a government authority operating within New York.

The document is provided in Italian. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DOH-5247IT?
A: Form DOH-5247IT is a Medicaid Authorized Representative Designation/Change Request form.

Q: Who is this form for?
A: This form is for residents of New York who need to designate or change their Medicaid Authorized Representative.

Q: What is the purpose of this form?
A: The form is used to designate or change a person who can act on behalf of a Medicaid recipient.

Q: Do I need to fill out this form if I already have an authorized representative?
A: No, you only need to fill out this form if you need to designate a new representative or change your existing representative.

Q: Are there any specific language requirements for this form?
A: Yes, Form DOH-5247IT is available in Italian.

Q: Is there a deadline for submitting this form?
A: There is no specific deadline mentioned. However, it is recommended to submit the form as soon as possible.

Q: Is there any fee associated with this form?
A: There is no information provided about any fee associated with this form.