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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHS1100B
for the current year.
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 - Hawaii
What Is Form DHS1100B?
This is a legal form that was released by the Hawaii Department of Human Services - a government authority operating within Hawaii. Check the official instructions before completing and submitting the form.
FAQ
Q: What is DHS1100B Supplemental Form?
A: DHS1100B Supplemental Form is a form for individuals who are applying for coverage on the basis of age, blindness or disability and/or requests for long-term care services in Hawaii.
Q: Who should use DHS1100B Supplemental Form?
A: Individuals who are applying for coverage on the basis of age, blindness or disability and/or requesting long-term care services in Hawaii should use DHS1100B Supplemental Form.
Q: What information is required on DHS1100B Supplemental Form?
A: DHS1100B Supplemental Form requires information related to age, blindness or disability, as well as details about the long-term care services being requested.
Q: Is DHS1100B Supplemental Form mandatory?
A: Yes, if you are applying for coverage on the basis of age, blindness or disability and/or requesting long-term care services in Hawaii, DHS1100B Supplemental Form is mandatory.
Form Details:
- Released on January 1, 2016;
- The latest edition provided by the Hawaii Department of Human Services;
- 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 fillable version of Form DHS1100B by clicking the link below or browse more documents and templates provided by the Hawaii Department of Human Services.
Download 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 - Hawaii
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