This version of the form is not currently in use and is provided for reference only. Download this version of Form F-44614A Part A for the current year.

Form F-44614A Part A Application / Recertification - AIDS / HIV Drug Assistance Program and Insurance Assistance Program - Wisconsin

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What Is Form F-44614A Part A?

This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form F-44614A?
A: Form F-44614A is an application/recertification form for the AIDS/HIV Drug Assistance Program and Insurance Assistance Program in Wisconsin.

Q: What are the AIDS/HIV Drug Assistance Program and Insurance Assistance Program in Wisconsin?
A: The AIDS/HIV Drug Assistance Program and Insurance Assistance Program provide financial assistance for medications and insurance premiums for individuals with AIDS/HIV in Wisconsin.

Q: Who needs to fill out Form F-44614A?
A: Individuals who are applying for or recertifying for the AIDS/HIV Drug Assistance Program and Insurance Assistance Program in Wisconsin need to fill out Form F-44614A.

Q: What information is required on Form F-44614A?
A: Form F-44614A requires information such as personal details, income, insurance information, and documentation of HIV status and residency.

Q: Is there a deadline for submitting Form F-44614A?
A: Yes, there is a deadline for submitting Form F-44614A. The specific deadline can be obtained from the Wisconsin Department of Health Services.

Q: What happens after I submit Form F-44614A?
A: After submitting Form F-44614A, your application/recertification will be reviewed by the Wisconsin Department of Health Services, and you will be notified of the outcome.

Q: Who should I contact if I have questions about Form F-44614A?
A: If you have questions about Form F-44614A, you can contact the Wisconsin Department of Health Services for assistance.

Form Details:

Released on November 1, 2021;
The latest edition provided by the Wisconsin Department of Health 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 F-44614A Part A by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.