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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 DHCS4461
for the current year.
Form DHCS4461 Health Access Programs Family Pact Program Client Eligibility Certification (Cec) - California
What Is Form DHCS4461?
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the DHCS4461 form?
A: The DHCS4461 form is the Health Access ProgramsFamily Pact Program Client Eligibility Certification (CEC) form.
Q: What is the purpose of the DHCS4461 form?
A: The purpose of the DHCS4461 form is to determine eligibility for the Family Pact Program in California.
Q: Who is eligible for the Family Pact Program?
A: The Family Pact Program is available to low-income individuals and families in California with limited or no health insurance coverage.
Q: What information is required on the DHCS4461 form?
A: The DHCS4461 form requires information such as income, household size, and proof of residency.
Q: Is there a deadline to submit the DHCS4461 form?
A: There is no specific deadline to submit the DHCS4461 form, but it is recommended to apply as soon as possible to ensure timely coverage.
Form Details:
- Released on November 1, 2016;
- The latest edition provided by the California Department of Health Care 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 DHCS4461 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form DHCS4461 Health Access Programs Family Pact Program Client Eligibility Certification (Cec) - California
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