This version of the form is not currently in use and is provided for reference only. Download this version of Instructions for Form DHS1100B for the current year.

Instructions for 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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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

This document contains official instructions for 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 - a form released and collected by the Hawaii Department of Human Services. An up-to-date fillable Form DHS1100B is available for download through this link.

FAQ

Q: What is Form DHS1100B?
A: Form DHS1100B is a supplemental form for individuals applying for coverage on the basis of age, blindness or disability and/or requests for long-term care services in Hawaii.

Q: Who needs to fill out Form DHS1100B?
A: Individuals applying for coverage on the basis of age, blindness or disability and/or requesting long-term care services in Hawaii need to fill out Form DHS1100B.

Q: What information does Form DHS1100B require?
A: Form DHS1100B requires information about the applicant's age, blindness or disability, and the type of long-term care services being requested.

Q: Is Form DHS1100B specific to Hawaii?
A: Yes, Form DHS1100B is specifically for individuals applying for coverage and/or requesting long-term care services in Hawaii.

Q: Are there any fees associated with submitting Form DHS1100B?
A: There are no fees associated with submitting Form DHS1100B.

Q: Is there a deadline for submitting Form DHS1100B?
A: There is no specific deadline for submitting Form DHS1100B, but it is recommended to submit it as soon as possible after determining eligibility for coverage or long-term care services.

Q: Do I need to provide supporting documents with Form DHS1100B?
A: Yes, you may need to provide supporting documents such as proof of age, blindness or disability, and income verification with Form DHS1100B.

Instruction Details:

This 2-page document is available for download in PDF;
Actual and applicable for the current year;
Complete, printable, and free.

Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Hawaii Department of Human Services.