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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 Program Family Pact Program Client Eligibility Certification - 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 DHCS4461?
A: DHCS4461 is a form used for the Health Access ProgramFamily Pact Program Client Eligibility Certification in California.
Q: What is the Health Access Program?
A: The Health Access Program is a program in California that provides family planning services to low-income individuals.
Q: What is the Family Pact Program?
A: The Family Pact Program is a part of the Health Access Program that specifically provides family planning services.
Q: Who can use the Family Pact Program?
A: The Family Pact Program is available to individuals who meet certain income and eligibility requirements in California.
Q: What is Client Eligibility Certification?
A: Client Eligibility Certification is a process to determine if an individual qualifies for the Family Pact Program.
Q: What is the purpose of DHCS4461?
A: DHCS4461 is used to certify the client's eligibility for the Family Pact Program.
Q: What information is required on DHCS4461?
A: DHCS4461 requires personal and financial information, such as your name, address, income, and household size.
Q: Is DHCS4461 only for California residents?
A: Yes, DHCS4461 is specifically for California residents who wish to apply for the Family Pact Program.
Q: How often do I need to submit DHCS4461?
A: DHCS4461 needs to be submitted annually or whenever there are changes to your eligibility status or information.
Form Details:
- Released on October 1, 2021;
- 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 Program Family Pact Program Client Eligibility Certification - California
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