PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form MC14 A
for the current year.
Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Punjabi)
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.
The document is provided in Punjabi. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the MC14 A form?
A: The MC14 A form is an application for Qualified Low-Income Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individuals (QI) programs.
Q: Who is eligible for QMB, SLMB, and QI programs?
A: Low-income individuals who receive or are eligible for Medicare can be eligible for these programs.
Q: What is the purpose of QMB, SLMB, and QI programs?
A: These programs help eligible individuals pay for their Medicare premiums and other medical costs.
Q: Is the MC14 A form specific to California?
A: Yes, the MC14 A form is specifically for California residents.
Q: Is the MC14 A form available in Punjabi language?
A: Yes, the MC14 A form is available in Punjabi for those who prefer to communicate in that language.
Form Details:
- Released on March 1, 2021;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a fillable version of Form MC14 A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form MC14 A Qualified Low-Income Medicare Beneficiary (Qmb), Specified Low-Income Medicare Beneficiary (Slmb), and Qualifying Individuals (Qi) Application - California (Punjabi)
1
2
3
4
