Form Dhcs 0006 - California Proof Of Citizenship Or Identity Needed (Armenian) - Health And Human Services Agency
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1State of California – Health and Human Services Agency
Department of Health Care Services
ø³Õ³ù³óÇáõÃÛ³Ý Ï³Ù ÇÝùÝáõÃÛ³Ý Ù³ëÇÝ ³å³óáõÛó, áñ ³ÝÑñ³Å»ßï ¿
Medi-Cal-Ç ¹ÇÙáÕ ØdzóÛ³É Ü³Ñ³Ý·Ý»ñÇ ù³Õ³ù³óÇÝ»ñÇ »õ ù³Õ³ù³óÇ ¹³ñÓ³Í ³ÝÓ³Ýó ѳٳñ
ٻͳٳëÝáõÃÛáõÝÁ
Üáñ ûñ»ÝùÝ ³ëáõÙ ¿` Medi-Cal-Á ¹ÇÙáÕÝ»ñÇ »õ Ýå³ëï³éáõÝ»ñÁ
, áñ ØdzóÛ³É Ü³Ñ³Ý·Ý»ñÇ
»õ
ù³Õ³ù³óÇ ¿ ϳ٠ù³Õ³ù³óÇ ¹³ñÓ³Í ³ÝÓ, å³ñï³íáñ ¿ ³å³óáõÛó Ý»ñϳ۳óÝ»É ù³Õ³ù³óÇáõÃÛ³Ý
ÇÝùÝáõÃÛ³Ý Ù³ëÇÝ։ ÊݹñáõÙ »Ýù Ý»ñϳ۳óÝ»É Ý»ñù»õáõÙ Ýßí³Í ï»Õ»ÏáõÃÛáõÝÝ»ñÁ ÙÇÝã»õ
¸ÇÙáÕÇ Ï³Ù Ýå³ëï³éáõÇ ³ÝáõÝÁ
(²é³çÇÝ, ÙÇçÇÝ, ³½·³ÝáõÝ)
²Ûë ³ÝÓÁ ³½³ïí³Í ¿ ϳ٠ѳٳå³ï³ë˳ÝáõÙ ¿ å³ÛÙ³ÝÝ»ñÇÝ: Ø»Ýù Éñ³óáõóÇã ³å³óáõÛóÇ Ï³ñÇù ãáõÝ»Ýù:
ÇÝùÝáõÃÛ³Ý
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
ù³Õ³ù³óÇáõÃÛ³Ý
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
ù³Õ³ù³óÇáõÃÛ³Ý
ÇÝùÝáõÃÛ³Ý
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
»õ
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
Ø»Ýù ã»Ýù ϳñáÕ³ÝáõÙ ·ïÝ»É ³Ûë ³ÝÓÇ ÍÝÝ¹Û³Ý ³ñӳݳ·ñáõÃÛáõÝÁ: ºÃ» ³Ûë ³ÝÓÁ ÍÝí»É ¿ γÉÇýáñÝdzÛáõÙ,
γÉÇýáñÝdzÛÇ ÌÝÝ¹Û³Ý ²ñӳݳ·ñáõÃÛ³Ý Êݹñ³·ñÇ
ËݹñáõÙ »Ýù Éñ³óÝ»É Ý»ñ÷³Ï ·ïÝíáÕ
(Request for
California Birth Record) Ó»õÁ »õ í»ñ³¹³ñÓÝ»É ³ÛÝ:
¸ÇÙáÕÇ Ï³Ù Ýå³ëï³éáõÇ ³ÝáõÝÁ
(²é³çÇÝ, ÙÇçÇÝ, ³½·³ÝáõÝ)
²Ûë ³ÝÓÁ ³½³ïí³Í ¿ ϳ٠ѳٳå³ï³ë˳ÝáõÙ ¿ å³ÛÙ³ÝÝ»ñÇÝ: Ø»Ýù Éñ³óáõóÇã ³å³óáõÛóÇ Ï³ñÇù ãáõÝ»Ýù:
ÇÝùÝáõÃÛ³Ý
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
ù³Õ³ù³óÇáõÃÛ³Ý
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
ù³Õ³ù³óÇáõÃÛ³Ý
»õ
ÇÝùÝáõÃÛ³Ý
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
Ø»Ýù ã»Ýù ϳñáÕ³ÝáõÙ ·ïÝ»É ³Ûë ³ÝÓÇ ÍÝÝ¹Û³Ý ³ñӳݳ·ñáõÃÛáõÝÁ: ºÃ» ³Ûë ³ÝÓÁ ÍÝí»É ¿ γÉÇýáñÝdzÛáõÙ,
γÉÇýáñÝdzÛÇ ÌÝÝ¹Û³Ý ²ñӳݳ·ñáõÃÛ³Ý Êݹñ³·ñÇ
ËݹñáõÙ »Ýù Éñ³óÝ»É Ý»ñ÷³Ï ·ïÝíáÕ
(Request for
California Birth Record) Ó»õÁ »õ í»ñ³¹³ñÓÝ»É ³ÛÝ:
¸ÇÙáÕÇ Ï³Ù Ýå³ëï³éáõÇ ³ÝáõÝÁ
(²é³çÇÝ, ÙÇçÇÝ, ³½·³ÝáõÝ)
²Ûë ³ÝÓÁ ³½³ïí³Í ¿ ϳ٠ѳٳå³ï³ë˳ÝáõÙ ¿ å³ÛÙ³ÝÝ»ñÇÝ: Ø»Ýù Éñ³óáõóÇã ³å³óáõÛóÇ Ï³ñÇù ãáõÝ»Ýù:
ÇÝùÝáõÃÛ³Ý
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
ù³Õ³ù³óÇáõÃÛ³Ý
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
ù³Õ³ù³óÇáõÃÛ³Ý
ÇÝùÝáõÃÛ³Ý
ÊݹñáõÙ »Ýù ³Ûë ³ÝÓÇ
»õ
Ù³ëÇÝ ³å³óáõÛó Ý»ñϳ۳óÝ»É:
Ø»Ýù ã»Ýù ϳñáÕ³ÝáõÙ ·ïÝ»É ³Ûë ³ÝÓÇ ÍÝÝ¹Û³Ý ³ñӳݳ·ñáõÃÛáõÝÁ: ºÃ» ³Ûë ³ÝÓÁ ÍÝí»É ¿ γÉÇýáñÝdzÛáõÙ,
γÉÇýáñÝdzÛÇ ÌÝÝ¹Û³Ý ²ñӳݳ·ñáõÃÛ³Ý Êݹñ³·ñÇ
ËݹñáõÙ »Ýù Éñ³óÝ»É Ý»ñ÷³Ï ·ïÝíáÕ
(Request for
California Birth Record) Ó»õÁ »õ í»ñ³¹³ñÓÝ»É ³ÛÝ:
ºÃ» ¹áõù ãáõÝ»ù í»ñ»õáõÙ å³Ñ³Ýçí³Í ï»Õ»ÏáõÃÛáõÝÁ, μ³Ûó ³ß˳ïáõÙ »ù Ó»éù μ»ñ»É ³ÛÝ, ËݹñáõÙ »Ýù Ù»½
ï»Õ»Ï³óÝ»ù: γå ѳëï³ï»ù Ó»ñ ï»Õ³Ï³Ý êáóÇ³É³Ï³Ý Ì³é³ÛáõÃÛáõÝÝ»ñÇ ·ñ³ë»ÝÛ³ÏÇ Ñ»ï ϳ٠Éñ³óñ»ù
ø³Õ³ù³óÇáõÃÛ³Ý Ù³ëÇÝ ïñ³Ù³μ³Ý³Ï³Ý ³å³óáõÛó Ó»éù μ»ñ»Éáõ ѳëï³ï³·ñÇ
Ý»ñ÷³Ï ·ïÝíáÕ
(Affidavit
of Reasonable Effort to Get Proof of Citizenship)Ó»õÁ »õ í»ñ³¹³ñÓñ»ù ³ÛÝ:
ø³áõÝÃÇÝ ÏÉñ³óÝÇ ³Ûë ëÛáõݳÏÁ:
County fills out this box.
Case No:
Case Name:
DHCS 0006 (Armenian) (08/07)
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