Form Dhcs 0002 - California Proof Of Citizenship And Identity New Requirements For Medi-Cal Beneficiaries Who Are U.s. Citizens Or Nationals (Arabic) - Health And Human Services Agency
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4State of California – Health and Human Services Agency
Department of Health Care Services
وﺛﺎﺋق اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ
ﻣﺗطﻠﺑﺎت ﺟدﻳدة ﻟﻠﻣﺳﺗﻔﻳدﻳن ﻣن ﺑرﻧﺎﻣﺞ
Medi-Cal
ﻟﻠﻣواطﻧﻳن اﻷﻣرﻳﻛﻳﻳن واﻟذﻳن ﻳﺣﻣﻠون اﻟﺟﻧﺳﻳﺔ اﻷﻣرﻳﻛﻳﺔ
ﻣن اﻟﻣواطﻧﻳن اﻷﻣرﻳﻛﻳﻳن أو ﻣن اﻟذﻳن ﻳﺣﻣﻠون اﻟﺟﻧﺳﻳﺔ
ﻗﺎﻧون ﺟدﻳد ﻳﻧص ﻋﻠﻰ ان ﻣﻌظم اﻟﻣﺳﺗﻔﻳدﻳن ﻣن ﺑرﻧﺎﻣﺞ
Medi-Cal
.اﻷﻣرﻳﻛﻳﺔ ﻳﺟب ان ﻳﻘدﻣوا وﺛﻳﻘﺔ اﺛﺑﺎت ﺟﻧﺳﻳﺔ واﺛﺑﺎت ﺷﺧﺻﻳﺔ. اﻗرأ اﻟﺗﺎﻟﻲ ﻟﻣﻌرﻓﺔ ﻓﻳﻣﺎ اذا ﻛﺎن ﻫذا اﻟﻘﺎﻧون ﻳﻧطﺑق ﻋﻠﻳك
.إذا ﻟم ﺗﻛن اﻣرﻳﻛﻲ اﻟﺟﻧﺳﻳﺔ، ﻫذه اﻟﺗﻌدﻳﻼت ﻻ ﺗﻧطﺑق ﻋﻠﻳك
:اﻟﻘﺎﻧون اﻟﺟدﻳد ﻻ ﻳﻧطﺑق ﻋﻠﻰ اﻟﻣواطﻧﻳن أو ذوي اﻟﺟﻧﺳﻳﺔ اﻷﻣرﻳﻛﻳﺔ ﻓﻲ اﻟﺣﺎﻻت اﻟﺗﺎﻟﻳﺔ
راﺗب ﺿﻣﺎن اﺟﺗﻣﺎﻋﻲ
:• أي ﺷﺧص ﻋﻧده
(SSI)
–
ﺑرﻧﺎﻣﺞ ﻣﻳدي ﻛﻳر
Medicare
–
ﺗﺄﻣﻳن ﺿﻣﺎن اﺟﺗﻣﺎﻋﻲ ﻟﻠﻌﺟز
(SSDI)
–
.ﺑﻧﺎء ا ً ﻋﻠﻰ ﻧوع ﻋﺟزﻫم
ﺗﺄﻣﻳن ﺿﻣﺎن اﺟﺗﻣﺎﻋﻲ ﻟﻠﻣﺗﻘﺎﻋدﻳن واﻟﻌﺟزة
(RSI-Title II)
–
وﺗﻘدم ﺑطﻠب اﺳﺗﺣﻘﺎق رﻋﺎﻳﺔ ﻗﺎﺻر
• اي ﺷﺧص ﺗﺣت ﻋﻣر
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• أطﻔﺎل ﻣوﻟودﻳن ﻣن اﻣﻬﺎت ﻣﺷﺗرﻛﺎت ﺑﺑرﻧﺎﻣﺞ ﻣﻳدي ﻛﺎل
Medi-Cal
•
Kin-GAP اﻷطﻔﺎل ﻓﻲ اﻟﺮﻋﺎﻳﺔ اﻟﻤﺆﻗﺘﺔ، أو ﻣﺴﺎﻋﺪة اﻟﺘﺒﻨﻲ، أو
“• اطﻔﺎل ﻓﻲ ﺑرﻧﺎﻣﺞ ”رﻋﺎﻳﺔ اﻟطﻔل اﻟﻣﻬﺟور
• اﻟﻣﻧﺗﻔﻌﻳن ﻣن ﺑرﻧﺎﻣﺞ
CalWORKs
اﻟﻰ ﻣﺗﻰ ﺗﺳﺗﻣر ﻓﺗرة ﺗﻐطﻳﺗﻲ؟
ﻣﺎذا ﻟو ﻟم اﻛن واﺣد ا ً ﻣن اﻟﻣذﻛورﻳن اﻋﻼه؟
ﺳوف ﺗﺳﺗﻣر اذا
اﻟﺧدﻣﺎت اﻟﺗﻲ ﺗﺣﺻل ﻋﻠﻳﻬﺎ ﻣن
اذا ﻛﻧت ﻣواطن اﻣرﻳﻛﻲ أو ﺗﺣﻣل اﻟﺟﻧﺳﻳﺔ اﻷﻣرﻳﻛﻳﺔ، ﻳﺟب
Medi-Cal
ﻛﺎﻧت ﺗﻧطﺑق ﻋﻠﻳك ﺟﻣﻳﻊ اﻟﻣﺗطﻠﺑﺎت اﻟﻘﺎﻧوﻧﻳﺔ اﻻﺧرى وﺗﻘوم
أن ﺗزودﻧﺎ ﺑوﺛﻳﻘﺔ اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ ﻻﺳﺗﻣرار ﻗﺑوﻟك
ﺑﺟﻬد ﻣﻧطﻘﻲ ﻟﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ. ﻳﺟب ان
اﻧظر ﻓﻲ اﻟﺻﻔﺣﺔ
ﻓﻲ ﺑرﻧﺎﻣﺞ ﻣﻳدي ﻛﺎل
3
) .Medi-Cal
.ﺗﺧﺑر اﻟﻣوظف اﻟﻣﺳؤول اﻧك ﺗﺣﺎول اﻟﺣﺻول ﻋﻠﻰ وﺛﻳﻘﺔ اﺛﺑﺎت
.ﻋﻠﻰ ﻗﺎﺋﻣﺔ اﻟوﺛﺎﺋق اﻟﻣﻘﺑوﻟﺔ ﻻﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ
(
اﻟﻣواطﻧون اﻷﻣرﻳﻛﻳون ﻳﺷﻣﻠﻬم اﻷﺷﺧﺎص اﻟﻣوﻟودﻳن
وأﺷﺧﺎص
ﺑﻣﺎ ﻓﻳﻬﺎ ﺟزﻳرة ﺳواﻳن
ﻓﻲ ﺳﺎﻣوا اﻻﻣرﻳﻛﻳﺔ
(
)
ﻛﻳف ﻳﻣﻛﻧﻧﻲ أن أﺣﺻل ﻋﻠﻰ وﺛﻳﻘﺔ اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ؟
.ﻣﻌﻳﻧﻳن ﻣن ﻛوﻣﻧوﻳﻠث ﺟزر ﻣﺎرﻳﺎﻧﺎ اﻟﺷﻣﺎﻟﻳﺔ
اذا ﻛﻧت ﻣوﻟود ا ً ﻓﻲ ﻛﺎﻟﻳﻔورﻧﻳﺎ، ﻳﻣﻛن ﻟﻠﻣﻘﺎطﻌﺔ اﻟﺗﻲ ﺗﺗﺑﻊ
ﺳﺟل اﻟوﻻدة ﻫو دﻟﻳل
.ﻟﻬﺎ أن ﺗﺣﺻل ﻋﻠﻰ ﺳﺟل وﻻدﺗك
)
.اﺛﺑﺎت ﺟﻧﺳﻳﺔ
(
ﻣﺎذا ﻟو ﻟم أﻛن اﺣﻣل اﻟﺟﻧﺳﻳﺔ اﻻﻣرﻳﻛﻳﺔ؟
اﻣﻸ ﻧﻣوذج ”طﻠب ﺳﺟل وﻻدة ﻓﻲ ﻛﺎﻟﻳﻔورﻧﻳﺎ“ ﻟﺗﻘوم
،اذا ﻟم ﺗﻛن ﻣواطن اﻣرﻳﻛﻲ أوﺗﺣﻣل اﻟﺟﻧﺳﻳﺔ اﻷﻣرﻳﻛﻳﺔ
اﻟﻣﻘﺎطﻌﺔ ﺑطﻠب ﺳﺟل وﻻدﺗك. ﺛم، ارﺳل أو ﺧذ اﻟطﻠب اﻟﻰ
ﺳﻳﻛون ﻋﻠﻳك ﻓﻘط ﺗﻘدﻳم اﻟوﺛﺎﺋق اﻟﺗﻲ ﻛﺎﻧت ﻣطﻠوﺑﺔ ﻣﻧك
ﻣرﻛز اﻟﺧدﻣﺔ اﻷﺟﺗﻣﺎﻋﻳﺔ اﻟﻣﺣﻠﻲ. وإذا ﻟم ﻳﻛن ﻣن اﻟﻣﻣﻛن
.ﺳﺎﺑﻘ ﺎ ً. ﻟم ﻳﺗﻐﻳر ﺷﻲء
.إﻳﺟﺎد ﺳﺟل وﻻدة، ﻓﺳﻳﻛون ﻋﻠﻳك ﺗوﻓﻳر إﺛﺑﺎت ﺟﻧﺳﻳﺔ آﺧر
.ﻋﻠﻰ ﻗﺎﺋﻣﺔ اﻟوﺛﺎﺋق اﻟﻣﻘﺑوﻟﺔ
اﻧظر ﻓﻲ اﻟﺻﻔﺣﺔ
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اﺳﺗﻔﺳرﻣن اﻟﻣﻘﺎطﻌﺔ اﻟﺗﺎﺑﻊ ﻟﻬﺎ ﻋن ﻛﻳﻔﻳﺔ اﻟﺣﺻول ﻋﻠﻰ
.وﺛﻳﻘﺔ اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ اذا ﻟم ﺗﻛن ﻣوﻟودا ﻓﻲ ﻛﺎﻟﻳﻔورﻧﻳﺎ
راﺟﻊ اﻟﻣﻘﺎطﻌﺔ ﻟﻣﻌرﻓﺔ ﻓﻳﻣﺎ اذا ﺗم إﻳﺟﺎد ﺳﺟل وﻻدة
.ﻳﻧطﺑق ﻋﻠﻳك ﻗﺑل ان ﺗدﻓﻊ ﺑدل اﺻدار ﺷﻬﺎدة ﻣﻳﻼد
DHCS 0002 (01/08) – Arabic
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