The purpose of this form is to exchange information with the Social Security offices. The Department of Community Health, Community Health Services, or their agents also use this form for “determination of level of care” purposes. The Department initiating the form is called the “originating department.”

The DHS-3471, DHS/SSA, form is used for the request for increase in income. • SSI funding-If the licensed facility accepts the SSI income amount; the rate available constitutes payment in full by SSI. No additional funds can be paid to the facility for food, clothing, or shelter.

A packet containing an application for assistance, an information booklet and a filing form. The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that you'll need to print and complete the application, and then take it to your local MDHHS office.

If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you. If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you.

2022年3月8日 · We support individuals with mental illness, intellectual/developmental disabilities, and substance use disorders focusing on integrated health care and recovery.

DHS/SSA-3471 Form. This item provides a description of the following pre-placement process, Supplemental Security Income (SSI), State Disability Assistance (SDA), Placement, Responsible Agency, Assisted Placement, Voluntary relocation, 16 and 17 years old in AFC placement, youth aging out of MDHHS foster care and use of the DHS/SSA-3471 form.

2024年11月15日 · Forms for long-term services and supports (LTSS) assessment, eligibility and support planning are located on CBSM – Forms for LTSS assessment, eligibility and support planning. PCA forms are now located in the PCA Manual. List of DHS forms lead agencies frequently use related to disability services.

The purpose of this form is to exchange information with the Social Security offices. The Department of Community Health, Community Health Services, or their agents also use this form for “determination of level of care” purposes. The Department initiating the form is called the “originating department.”

Execute Dhs 3471 within a couple of moments following the guidelines listed below: Select the template you want from our library of legal form samples. Click the Get form button to open the document and start editing.