PDF
Word
Form CMS-20049 Family Interview
What Is Form CMS-20049?
This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on July 1, 2012 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CMS-20049?
A: Form CMS-20049 is the Family Interview form.
Q: Who uses Form CMS-20049?
A: Form CMS-20049 is used by individuals and families.
Q: What is the purpose of the Family Interview?
A: The purpose of the Family Interview is to gather information about the individual or family's health care needs.
Q: What information is required on the form?
A: The form requires information such as the individual's name, address, date of birth, and current health care coverage.
Form Details:
- Released on July 1, 2012;
- The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form CMS-20049 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.
Download Form CMS-20049 Family Interview
1
2
3
4
5
6
7
8
