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Description of dss ea 240
DSS-EA-240 05/12 Recipient Section 2 Application for Long Term Care or Related Medical Assistance For Office Use Only Instructions to the Person Applying for Assistance Please read all questions carefully before filling out this form and any attached supplements. This information will be used in determining your eligibility and need for assistance. All questions on the form must be completed* If you need help...
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dss ea 240
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SD DSS-EA-240 Form Versions

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SD DSS-EA-240 2011 4.8 Satisfied
(207 Votes)
SD DSS-EA-240 2006 4.0 Satisfied
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