This is a legal form that was released by the New York State Office of Temporary and Disability Assistance - a government authority operating within New York.
The document is provided in Korean. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is LDSS-5024 Designated Representative Form?
A: LDSS-5024 Designated Representative Form is a form used in New York to appoint a designated representative for Medicaid purposes.
Q: Who can be a designated representative?
A: A designated representative can be a family member, friend, or other trusted individual who is willing and able to assist with Medicaid-related tasks.
Q: What are the responsibilities of a designated representative?
A: The responsibilities of a designated representative include helping with the Medicaid application process, managing the Medicaid benefits, and acting on behalf of the Medicaid recipient.
Q: Does the LDSS-5024 Designated Representative Form need to be notarized?
A: No, the LDSS-5024 Designated Representative Form does not need to be notarized, but it must be signed by both the Medicaid recipient and the designated representative.
Form Details:
Download a printable version of Form LDSS-5024 by clicking the link below or browse more documents and templates provided by the New York State Office of Temporary and Disability Assistance.