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Forms: DHCS 0-11
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DHCS 0001 (05/09) - U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity
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Arabic,
Armenian,
Chinese,
Farsi,
Hmong,
Cambodian,
Korean,
Laotian,
Russian,
Spanish,
Tagalog,
Vietnamese
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DHCS 0002 (01/08) - Proof of Citizenship and Identity--New Requirements for Medi-Cal Beneficiaries who are U.S. Citizens or Nationals
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Arabic ,
Armenian ,
Chinese ,
Farsi ,
Hmong ,
Cambodian ,
Korean ,
Laotian ,
Russian ,
Spanish ,
Tagalog ,
Vietnamese
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DHCS 0005 (02/08) - Receipt of Citizenship and Identity Documents
alt: Arabic ,
Armenian ,
Chinese ,
Farsi ,
Hmong ,
Cambodian ,
Korean ,
Laotian ,
Russian ,
Spanish ,
Tagalog ,
Vietnamese
- DHCS 0007 (12/07) - Acceptable Citizenship and Identity Documents
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Arabic ,
Armenian ,
Chinese ,
Farsi ,
Hmong ,
Cambodian ,
Korean ,
Laotian ,
Russian ,
Spanish ,
Tagalog ,
Vietnamese
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DHCS 0008 (01/08) - Proof of Citizenship and Identity Requirements - For Children who are U.S. Citizens or Nationals filling out the Heidhy Families/Medi-Cal Joint Application
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Arabic ,
Armenian ,
Chinese ,
Farsi ,
Hmong ,
Cambodian ,
Korean ,
Laotian ,
Russian ,
Spanish ,
Tagalog ,
Vietnamese
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DHCS 0009 (09/07) - Affidavit of Identity for U.S. Citizen or National Children Under 18
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Arabic ,
Armenian ,
Chinese ,
Farsi ,
Hmong ,
Cambodian ,
Korean ,
Laotian ,
Russian ,
Spanish ,
Tagalog ,
Vietnamese
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DHCS 0010 (01/08) - Affidavit of Identity for U.S. Citizens or National for Disabled Individuals Living in Institutional Care Facilities
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DHCS 0011 (06/08) - Proof of Acceptable Citizenship or Identity Documents
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Arabic,
Armenian ,
Chinese ,
Farsi ,
Hmong ,
Cambodian ,
Korean ,
Laotian ,
Russian ,
Spanish ,
Tagalog ,
Vietnamese
Last modified date:
6/15/2023 4:03 PM