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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 DHCS9119
for the current year.
Form DHCS9119 Health Insurance Premium Payment (HIPP) Program Release of Information - California
What Is Form DHCS9119?
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 DHCS9119 form?
A: The DHCS9119 form is the Health Insurance Premium Payment (HIPP) Program Release of Information form in California.
Q: What is the purpose of the DHCS9119 form?
A: The purpose of the DHCS9119 form is to authorize the release of information for the Health Insurance Premium Payment (HIPP) Program in California.
Q: Who uses the DHCS9119 form?
A: The DHCS9119 form is used by individuals participating in the Health Insurance Premium Payment (HIPP) Program in California.
Q: What information is released through the DHCS9119 form?
A: The DHCS9119 form authorizes the release of information related to the individual's health insurance coverage, premiums, and other relevant details.
Form Details:
- Released on June 1, 2019;
- 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 DHCS9119 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
