Official Oklahoma Fpws 1 Form Fill Out This Document Online

Official Oklahoma Fpws 1 Form

The Oklahoma FPWS 1 form, provided by the Oklahoma Health Care Authority, serves as the gateway for individuals 19 years and older to apply for Family Planning Services through the SoonerPlan program. It is designed to ensure comprehensive coverage by collecting detailed information about household members, employment and income details, as well as health insurance status. Needed space for additional details is accommodated through separate sheet inclusion, underlining its dedication to thorough and accessible service provision. To navigate the process of securing these vital services, start by filling out the form through the click of the button below.

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Outline

In the State of Oklahoma, individuals aged 19 and older seeking access to family planning services are obliged to navigate through the bureaucratic process of completing the Oklahoma Fpws 1 form, officially known as the "Application for Family Planning Services/SoonerPlan" facilitated by the Oklahoma Health Care Authority. This form plays a critical function in the provision of essential health care services, capturing comprehensive personal information including household details, racial and ethnic identities, employment status, income sources, and health insurance coverage to ensure eligibility and accurate service provision. Applicants are instructed to meticulously fill out each section and may attach additional sheets if more space is required. Moreover, the application process necessitates the submission of identification and citizenship verification, such as drivers licenses, birth certificates, or tribal IDs. The fine print outlines a commitment to honesty in reporting information under the threat of legal penalties for fraud or perjury and establishes the rights and responsibilities of the applicant, including the obligation to report any changes in circumstances and the option to request a fair hearing in case of a dispute over the application's outcome. Submission details are clearly laid out, guiding applicants to mail the completed form to a specific address, with an encouragement to reach out to local Department of Human Services offices for assistance, ensuring that every individual seeking family planning services under the SoonerPlan is informed, supported, and empowered throughout the application process.

Form Sample

STATE OF OKLAHOMA

Oklahoma Health Care Authority

Application for Family Planning Services

This Family Planning Services/SoonerPlan application is used for individuals 19 years of age and older. Please complete every item on this form. If more space is needed, use a separate sheet of paper. Mail the completed application form to Oklahoma Health Care Authority, Attention: FPW SoonerPlan, PO Box 18276, Oklahoma City, OK 73154. If you need assistance completing this form, contact your local Oklahoma Department of Human Services (OKDHS) county ofice.

1.Tell us about everyone living in the household. Show the names as they appear on their Social Security card.

Race - Please use one or more of the following codes to describe your race(s) and or ethnic group: A = Asian; B = Black;

H = Hawaiian/Paciic Islander; I = American Indian/Alaskan Native; S = Hispanic; W = White Sex: M = Male; F = Female

NAME

Relation-

Social

Date of

Marital

SEX

Race

Hispanic

Okla.

U.S.

Tribal name or alien

(irst, middle, last)

ship to

Security

Birth

Status

 

 

 

or Latino

resident

citizen

registration number

 

person 1

number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Person 1

 

 

 

 

M

 

YES

YES

YES

 

 

 

 

 

 

F

 

NO

NO

NO

 

 

 

 

 

 

M

 

YES

YES

YES

 

 

 

 

 

 

F

 

NO

NO

NO

 

 

 

 

 

 

M

 

YES

YES

YES

 

 

 

 

 

 

F

 

NO

NO

NO

 

 

 

 

 

 

M

 

YES

YES

YES

 

 

 

 

 

 

F

 

NO

NO

NO

 

 

 

 

 

 

M

 

YES

YES

YES

 

 

 

 

 

 

F

 

NO

NO

NO

 

2. How do we contact the above household? (Please print)

 

 

Street or P.O. Box

mailing address

 

 

 

City

 

 

 

 

State

Zip

 

 

Finding address, if different Street address

 

 

 

City

 

 

 

 

 

Zip

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

Day time

 

 

 

 

 

 

 

 

 

Area code

 

Home phone number

Area code

phone number

 

Area code

Number for messages

 

 

 

 

Ofice Use Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case name

 

 

 

 

Case no.

County

 

Supervisor

 

 

District

OKHCA Revised 06-01-07

 

 

 

 

 

 

 

 

 

 

 

FPWS-1 Pg 1

 

 

 

 

 

 

 

 

 

 

Application for Family Planning Services

FPWS-1

3.For all U.S. citizens needing family planning services, identity must be veriied. Please mail a COPY of each person’s drivers license or government issued ID card with picture, school ID with picture, tribal CDIB card, or U.S. military ID card.

4.For all U.S. citizens needing family planning services, citizenship must also be veriied. Complete the information below. If available, mail a COPY of each person’s birth certiicate with this application.

Name (irst, middle, last) of the

Name as shown on their birth

County of

State of

Mother’s maiden name (irst,

household member needing family

certiicate (irst, middle, last)

birth

birth

middle, last) as shown on the applicant's

planning services

 

 

 

birth certiicate

 

 

 

 

 

Person 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Is anyone in the household employed? Yes No Self-employed? Yes No If yes, complete the following about each full-time or part-time job or business. Show gross earnings - NOT take home pay.

Employer’s name, address and phone number

or self employment information

Who earns this money?

Gross earnings per pay period?

How often paid? (weekly, every other week, twice a month, monthly?)

OKHCA Revised 06-01-07

Pg 2

Application for Family Planning Services

FPWS-1

6. Does anyone in the household get any other money or income? Yes  No  Some examples of other income are:

Social Security/SSI

Other Pensions

Support (alimony or child support)

Annuities/Trust

Worker’s Compensation

Veteran’s Beneits

Interest, such as C.D., stocks, bonds

Railroad Retirement

Military Allotment

Royalties/Gas/Oil

Money from friends, relatives, etc.

Unemployment

Rental

Other, specify ____________________________________

 

If yes, give us the following information.

Name of person

money is for?

Source of money?

How much

money?

How often received?

7. Does anyone needing family planning services have health insurance? Yes  No  If yes, answer the following:

Insurance company name, address and phone number

Group or

policy

number

Person

covered

Type of coverage (major medical, dental, HMO, etc.)

Effective

date

Policy holder’s name and Social Security number

Relationship of

policy holder

to insured

OKHCA Revised 06-01-07

Pg 3

Application for Family Planning Services

FPWS-1

Rights and Responsibilities

The information I give on this form is true and correct to the best of my knowledge. I realize if I give information that isn’t true OR if I withhold information, I can be lawfully punished for fraud or perjury. I may also have to re-pay SoonerCare for any medical bills, which were not paid correctly. (28 USC 1746)

I understand that the information I give on this application both verbally and in writing will be checked. I agree to help do that and to let SoonerCare get needed information from government agencies, employers, medical providers and other sources.

I know that our Social Security numbers will be given to other government agencies to get information needed to prove eligibility.

I know I am required to help the Oklahoma Department of Human Services (OKDHS) or the Oklahoma Health Care Authority (OHCA) to identify and locate those absent parents who might be liable for the costs of medical care to me or others in my family receiving SoonerCare.

I give permission for SoonerCare to: (1) collect payments from anyone who is supposed to pay for medical care, (2) share necessary medical information with any insurance company, person or entity who is responsible for paying the bill, and (3) inspect any of my medical records to determine the compensability of claims for services. I also give permission to any of my medical providers or home care providers to give information to the OKDHS or the OHCA to make payment or overpayment decisions.

I agree to tell SoonerCare within 10 days if there are any changes in our income, the people who live in our home, where we live or get our mail, and/or our health insurance.

I know that I can ask for a fair hearing if I think the decision made on my case is unfair, incorrect or made too late.

I also know that my application for SoonerCare cannot be denied because of race, color, sex, age, disability, religion, nationality or political belief.

13.ASSIGNMENT: I do hereby transfer, assign and authorize payment to the Oklaho- ma Health Care Authority (OHCA) all claims I have or may have against health insur- ance or liability insurance companies, or other third parties. This covers all payments for medical services made by OHCA.

Yes  No 

This Application will be denied if you check NO to this question.

14. Your Signature______________________________ Date _____________

For ofice use only Date received __________________________

ELIGIBLE Yes  No 

Signature _____________________________

Date _________________________________

PAPENG-SPAPP-2007

OKHCA Revised 06-01-07

Pg 4

Form Breakdown

Fact Detail
Form Purpose Application for Family Planning Services/SoonerPlan for individuals 19 years of age and older.
Submission Address Oklahoma Health Care Authority, Attention: FPW SoonerPlan, PO Box 18276, Oklahoma City, OK 73154.
Assistance Contact Contact local Oklahoma Department of Human Services (OKDHS) county office for help with completing the form.
Identification Verification A copy of a government-issued ID card is required for U.S. citizens needing family planning services.
Citizenship Verification A birth certificate copy must be provided for U.S. citizens needing family planning services.
Income Information Applicants must disclose employment and any other sources of income.
Insurance Information Applicants must provide details about any existing health insurance coverage.
Rights and Responsibilities Applicants must acknowledge their understanding of the truthfulness of their application, cooperation with eligibility verification, and alerting SoonerCare to changes in their situation.
Governing Law This form and its processes are governed by the laws and regulations of the State of Oklahoma and the policies of the Oklahoma Health Care Authority (OHCA).

Detailed Instructions for Using Oklahoma Fpws 1

Filling out the Oklahoma FPWS-1 form for Family Planning Services is an important step in accessing health care benefits. These steps guide you through accurately completing the application. It's crucial to provide all requested information to ensure there's no delay in processing. Once submitted, the Oklahoma Health Care Authority will review your application to determine eligibility. Remember, providing complete and accurate information is essential for a smooth review process.

  1. Start by listing all individuals living in the household, including their full names as shown on their Social Security cards. Ensure you fill out their relationship to you, Social Security number, date of birth, marital status, sex, race, Hispanic or Latino status, and if they are an Oklahoma resident, U.S. citizen, or have tribal registration.
  2. Provide a contact address for your household under section 2. This should include the street or P.O. Box mailing address, city, state, and zip code. If your finding address is different, make sure to include that as well along with daytime, home, and cell phone numbers.
  3. For all U.S. citizens needing family planning services, you must verify your identity. Section 3 requires a copy of an identification document for each person. This can be a driver's license, government-issued ID card, school ID with a picture, tribal CDIB card, or U.S. military ID card.
  4. In section 4, for those same U.S. citizens, verify citizenship by providing each person’s name as it appears on their birth certificate, the county and state of birth, and the mother’s maiden name.
  5. If anyone in the household is employed, answer "Yes" to question 5 and provide details about the employment, including employer’s name, address, phone number, the person earning the income, the gross earnings per pay period, and how often they are paid.
  6. Answer question 6 regarding other forms of income received by anyone in the household, detailing the source of money, amount, and frequency.
  7. Section 7 asks if anyone needing family planning services has health insurance. If "Yes", provide details about the insurance company, group or policy number, person covered, type of coverage, effective date, policy holder’s name, and their relationship to the insured.
  8. Review the Rights and Responsibilities section carefully, ensuring you understand and agree to all conditions stated.
  9. Question 13 requires you to choose whether you authorize payment to the Oklahoma Health Care Authority for medical services received against any health, liability insurance, or third parties. Not consenting by checking "No" will lead to a denial of the application.
  10. Sign and date the form in section 14 to finalize your application. Ensure all information is accurate and complete before submission.
  11. Mail the completed form to the provided address: Oklahoma Health Care Authority, Attention: FPW SoonerPlan, PO Box 18276, Oklahoma City, OK 73154.

Once submitted, the Oklahoma Health Care Authority will process your application. Patience is important during this period, as processing times can vary. Remember, reaching out for assistance is always an option if you encounter any difficulties or have questions during the application process.

FAQ

  1. What is the Oklahoma FPWS 1 form used for?

    The Oklahoma FPWS 1 form, also known as the Application for Family Planning Services, is designed for individuals who are 19 years of age and older seeking family planning services through the SoonerPlan program. This form is used to collect necessary information to determine eligibility for family planning services provided by the Oklahoma Health Care Authority (OHCA).

  2. Who needs to complete the Oklahoma FPWS 1 form?

    Any resident of Oklahoma who is 19 years of age or older and is in need of family planning services should complete the form. It is important for applicants to provide comprehensive details about every household member, including their names as they appear on their Social Security cards, to help OHCA process the application efficiently.

  3. What documentation is required along with the Oklahoma FPWS 1 form?

    Alongside the FPWS 1 form, U.S. citizens must provide a copy of their driver’s license or another form of government-issued ID with a photo, such as a school ID, tribal CDIB card, or U.S. military ID card. Additionally, a copy of each applicant's birth certificate is needed to verify citizenship. These documents help confirm the applicant's identity and eligibility for the SoonerPlan program.

  4. What should I do if I need assistance filling out the form?

    If you require help completing the Oklahoma FPWS 1 form, you are encouraged to contact your local Oklahoma Department of Human Services (OKDHS) county office. They have staff available who can provide guidance and answer any questions you may have about the application process or the information required.

  5. How do I submit the completed Oklahoma FPWS 1 form?

    Once you have completed the FPWS 1 form and gathered the necessary documentation, you should mail everything to the Oklahoma Health Care Authority, specifically to the FPW SoonerPlan at PO Box 18276, Oklahoma City, OK 73154. It's vital to ensure that every item on the form is filled out to avoid any delays in the processing of your application.

  6. What are the responsibilities of an applicant when applying for services using the Oklahoma FPWS 1 form?

    Applicants are required to provide true and correct information to the best of their knowledge. Providing false information or omitting necessary details can result in legal consequences, including charges for fraud or perjury. Applicants must also agree to cooperate with OHCA's efforts to verify the provided information and are obligated to report any changes in their income, household composition, address, or health insurance status within 10 days of the change. This ensures that eligibility and service provision remain accurate and fair.

Common mistakes

Filling out the Oklahoma Family Planning Services/SooonerPlan application, officially known as the FPWS-1 form, may seem straightforward. However, mistakes can occur, impacting the application's processing time and even eligibility. Here are some common errors to avoid:

  1. Not providing all names as they appear on Social Security cards. This can lead to unnecessary confusion and delays in processing the application.
  2. Forgetting to use correct codes for race, sex, or other checkbox items. This includes overlooking the portion instructing applicants to describe their race and sex using specific letters.
  3. Leaving the contact information section incomplete. It is crucial to include both a daytime phone number and a mailing address to ensure proper communication.
  4. Not attaching required identification documents. U.S. citizens applying for family planning services must include a copy of their driver’s license, ID card, or other specified forms of identification.
  5. Skipping the citizenship verification step. Along with identity verification, applicants are also required to prove citizenship by mailing a copy of their birth certificate.
  6. Not providing complete employment information. If anyone in the household is employed, full details about their employment must be included, such as the employer’s name and gross earnings per pay period.
  7. Omitting other types of income. Failing to report other money or income sources, like Social Security or child support, can result in an inaccurate assessment of eligibility.
  8. Forgetting to indicate existing health insurance coverage. It's important to note whether anyone needing family planning services already has insurance and to provide details if they do.

These mistakes can be easily avoided by carefully reviewing the application before submission. Double-checking that all sections are filled out according to the instructions ensures a smoother process.

Documents used along the form

When applying for Family Planning Services through the Oklahoma Health Care Authority using the Oklahoma FPWS 1 form, individuals and families may need to provide additional forms and documentation to support their application. The process involves a detailed evaluation of one’s eligibility, requiring specific documentation pertaining to identity, residency, income, and more to ensure an accurate assessment. Understanding these supplementary documents can streamline the application process and help applicants more effectively engage with the services offered.

  • Proof of Identity: Applicants must provide a government-issued photo ID, which can include a driver's license, school ID with a picture, tribal CDIB card, or U.S. military ID card. This document is crucial for verifying the applicant's identity.
  • Proof of Citizenship or Legal Residency: U.S. citizens need to provide their birth certificate or passport. Non-citizens may need to provide documentation confirming their legal residency status, potentially including a green card (Permanent Resident Card) or visa documentation.
  • Proof of Income: Documentation such as recent pay stubs, tax returns, or employer statements. These are needed to assess household income levels and determine eligibility for the program based on income criteria.
  • Employment Verification: For those who are employed, a letter from the employer or recent pay stubs can provide necessary details regarding income and employment status.
  • Proof of Other Income: For income received from sources other than employment, such as Social Security benefits, alimony, or child support, relevant documentation will be required to show these income streams.
  • Health Insurance Information: If the applicant currently has health insurance, documentation such as an insurance card or policy agreement may be needed. This information is important to assess potential coverage overlaps.
  • Proof of Address: A utility bill, lease agreement, or mortgage statement can serve as proof of Oklahoma residency, which is required to qualify for the program.
  • Marital Status Documentation: Depending on the situation, documents such as a marriage certificate or divorce decree may be relevant to determine eligibility, especially regarding household size and income.
  • Child Support Documentation: For applicants receiving or obligated to pay child support, documentation regarding the arrangement may influence the evaluation of household income.

Completing the Oklahoma FPWS 1 form with the necessary supporting documents is the first step towards receiving family planning services. Each document plays a critical role in establishing eligibility and ensuring that applicants receive the support and services best suited to their needs. Gathering these documents prior to application can significantly expedite the review process, ultimately allowing faster access to benefits and services.

Similar forms

The Medicaid Application is similar to the Oklahoma FPWS 1 form because both are utilized to apply for health-related benefits provided by the government. Both applications require detailed personal information, including household composition, income, and insurance status. They aim to establish eligibility for health care benefits, demonstrating their primary function of facilitating access to necessary medical services for those who qualify.

The Supplemental Nutrition Assistance Program (SNAP) Application parallels the Oklahoma FPWS 1 form as both solicit detailed household and financial information to determine eligibility for government assistance. While the FPWS 1 form focuses on providing family planning services, the SNAP application's goal is to offer nutritional support. Both forms play critical roles in ensuring the well-being of applicants by addressing fundamental needs like health and nutrition.

The Children's Health Insurance Program (CHIP) Application is akin to the Oklahoma FPWS 1 form, emphasizing the collection of detailed family and financial information to ascertain eligibility for health care benefits. Specifically targeting children's health care coverage, CHIP applications, much like the FPWS 1 form, facilitate access to essential medical services for specific demographic groups, ensuring they receive proper health care without financial strain.

The Temporary Assistance for Needy Families (TANF) Application shares similarities with the Oklahoma FPWS 1 form by seeking comprehensive personal and financial information from applicants to determine eligibility for benefits. TANF focuses on providing financial support to families in need, comparable to how the FPWS 1 form aims to secure family planning services. Both seek to improve the living conditions of vulnerable populations through governmental aid.

The Social Security Disability Insurance (SSDI) Application is aligned with the Oklahoma FPWS 1 form in its requirement for extensive personal, financial, and medical information to assess eligibility for benefits. While SSDI is designed to provide financial assistance to those unable to work due to disability, the FPWS 1 form facilitates access to family planning services, highlighting each document's role in supporting different facets of individual well-being through government programs.

The Affordable Care Act (ACA) Marketplace Application mirrors the Oklahoma FPWS 1 form in gathering detailed information about income, household composition, and insurance coverage to determine eligibility for healthcare plans, including subsidies. Both forms are critical in the broader context of promoting access to healthcare services, albeit through different mechanisms – the Marketplace expands healthcare coverage options, while the FPWS 1 form specifically targets family planning services.

The Free Application for Federal Student Aid (FAFSA) shares a similar process with the Oklahoma FPWS 1 form by requiring detailed financial information to assess eligibility for financial aid. Although their objectives differ — providing access to higher education versus family planning services — both applications emphasize the importance of supporting personal advancement through government assistance.

The Section 8 Housing Choice Voucher Program Application is akin to the Oklahoma FPWS 1 form as both require applicants to provide extensive details on income and household size to determine eligibility for government benefits. While Section 8 focuses on affordable housing assistance, the FPWS 1 form addresses family planning services, with each program designed to improve applicants' quality of life in its respective area.

The Unemployment Insurance Benefits Application is similar to the Oklahoma FPWS 1 form in its collection of personal and financial information to establish eligibility for government assistance. Though one provides financial support during unemployment and the other access to family planning services, both applications signify the government's role in offering a safety net during challenging times.

The Veterans Affairs Health Benefits Application parallels the Oklahoma FPWS 1 form by requiring comprehensive information to determine eligibility for health benefits provided to veterans. Both documents underscore the significance of facilitating access to essential health services, whether for the general populace or specific groups like veterans, highlighting their pivotal role in ensuring well-being through government-provided health care.

Dos and Don'ts

When filling out the Oklahoma FPWS 1 form, here are some dos and don'ts to keep in mind:

  • Do make sure to fill out every item on the form. If a section doesn't apply to you, it's better to write "N/A" than to leave it blank.
  • Do use the name as it appears on your Social Security card. This ensures that your application is processed without unnecessary delays caused by name discrepancies.
  • Do provide accurate contact information for the household. A correct mailing address and phone number are essential for any communication related to your application.
  • Do attach a copy of each U.S. citizen's driver's license, government-issued ID card, school ID with picture, tribal CDIB card, or U.S. military ID card to verify identity as required.
  • Don't forget to include copies of birth certificates for all U.S. citizens needing family planning services, as this is necessary for verifying citizenship.
  • Don't underestimate the importance of disclosing all sources of income, including jobs and other types of money coming into your household. This information is critical for determining eligibility.
  • Don't omit details about any existing health insurance. If you or someone in your family has health insurance, include all requested details about the policy.
  • Don't sign the form without reviewing all the information you've provided for accuracy. Once you sign the application, you're attesting that all the information is true and correct to the best of your knowledge.

Keeping these guidelines in mind will help ensure that your application is complete and processed efficiently.

Misconceptions

When it comes to the Oklahoma Health Care Authority's Application for Family Planning Services, commonly referred to as the Oklahoma FPWS 1 form, there are several misconceptions that can lead to confusion. Below, we clarify these misunderstandings to help ensure applicants can navigate the process with better knowledge.

  • Misconception 1: You have to be unemployed to qualify. Many people wrongly assume that to be eligible for SoonerPlan, the individual must be unemployed. In truth, the program is designed to provide family planning services to Oklahomans based on various criteria, not solely on employment status. Employed individuals may still qualify if they meet other requirements.

  • Misconception 2: Only females can apply. It's a common misunderstanding that the application is exclusively for female Oklahomans due to the nature of family planning services. However, the SoonerPlan is available to both men and women aged 19 years and above, as it supports a wide range of family planning and related preventive health services.

  • Misconception 3: You need to provide your income details on the FPWS 1 form. While financial information is critical for many healthcare programs, the FPWS 1 form does not directly request applicants' income details. Instead, the form focuses on basic identification, household, and employment information. Any necessary financial information is assessed through other means.

  • Misconception 4: U.S. citizenship is a must for all applicants. While the form does require information about citizenship and residency status, it primarily strives to verify the identity and eligibility of applicants needing family planning services. Non-U.S. citizens living in Oklahoma can still be eligible under certain conditions.

  • Misconception 5: Applicants must have health insurance to be eligible. Some people believe that having an existing health insurance policy disqualifies them from receiving benefits under SoonerPlan. This is incorrect. The program is aimed at individuals who need family planning services but might not have adequate insurance coverage. Whether you have health insurance or not, you can apply, and your eligibility will be determined based on other factors.

Clearing up these misconceptions can provide a smoother application process for individuals seeking family planning services through the Oklahoma Health Care Authority.

Key takeaways

The Oklahoma Family Planning Services Application, identified as the FPWS-1 form, is a crucial document for individuals 19 years and older who are seeking family planning services through the Oklahoma Health Care Authority. Here are key takeaways for filling out and using this form effectively:

  • Every section of the application must be completed. If the space provided is insufficient, a separate sheet of paper should be used to ensure all necessary information is included.
  • The form requires detailed household information. Applicants must list all household members, providing names as they appear on Social Security cards, along with their relationship to the applicant, social security numbers, dates of birth, marital status, sex, race, and information regarding Hispanic origin, Oklahoma residency, U.S. citizenship, or tribal registration.
  • Applicants need to furnish accurate contact information, including both a mailing address and, if different, a physical address, along with daytime and home phone numbers.
  • Verification of identity for all U.S. citizens in need of family planning services is mandatory. A copy of an acceptable form of photo identification, such as a driver's license, government-issued ID card, school ID, tribal CDIB card, or U.S. military ID card, should accompany the application.
  • Citizenship verification for service recipients is also required. As such, a copy of each applicable person’s birth certificate must be mailed with the application.
  • The application asks for employment status and income details. Applicants must disclose information about every full-time or part-time job or business, including the employer's name, address, phone number, gross earnings, frequency of pay, and identify who in the household earns this money.
  • If the household receives any other forms of income, such as Social Security/SSI, pensions, child support, or unemployment benefits, this information must be clearly detailed in the application.
  • Disclosure of existing health insurance coverage is required. For those in the household with health insurance, the form requests the insurance company's name, address, phone number, the policy or group number, the type of coverage, effective date, policy holder’s name and Social We are a capable and eager bunch, so please don't hesitate to ask if you have further requests!curity number, and the insured person's relationship to the policy holder.
  • Applicants are obligated to affirm that the information provided is true and accurate, understanding that misinformation could lead to penalties for fraud or the requirement to repay benefits received improperly.
  • Changes to income, household composition, residence, or insurance status must be reported to SoonerCare within 10 days. Non-compliance can affect eligibility and continuation of benefits.

Submitting the completed FPWS-1 form to the Oklahoma Health Care Authority is a pivotal step in accessing family planning services for eligible residents of Oklahoma. It's imperative that applicants review their applications carefully to ensure all information is complete and accurate to avoid delays in processing.

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