Form Mc 175 P - Sneede V. Kizer Property Screening Questions
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1State of California—Health and Human Services Agency
Department of Health Care Services
SNEEDE V. KIZER
PROPERTY SCREENING QUESTIONS
If the MFBU has excess property and includes child(ren), complete the following:
County Use Only
Case name
County district
Case number
Effective date (month/day/year)
New Application
Redetermination
Change
Retroactive Eligibility
Correction
DOES THE MFBU INCLUDE:
YES
NO
a. A stepparent?
b. An unmarried couple with mutual children?
c. A child with his/her own nonexempt property?
d. A nonparent caretaker relative in the same MFBU with the children for whom care is provided and the
caretaker wants Medi-Cal?
If “NO” to all of the above, stop here.
If “YES” to any of the above and:
1. the MFBU includes a parent, complete MC 175-2, MC 175-3P, and MC 175-4.
2. the MFBU does not include a parent, complete MC 175-3P and MC 175-4.
Eligibility Worker signature
Worker number
Date
MC 175 P (05/07)
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