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State of California – Health and Human Services Agency

Department of Health Care Services

Kuv puas yuav tau muab tej puavpheej uas qhia tias

Yog kuv muab tsis tau tej puavpheej uas qhia tias kuv

yog neeg Amelikas thiab yog leejtwg tiag tuaj txhua

yog neeg Amelikas lossis yog leejtwg nev?

zaum uas kuv rov tuaj txuas ntaub ntawv thov?

Luag yuav ncua ib lub sijhawm rau koj los nrhiav thiab

muab koj cov puavpheej tuaj.

Tsis tau. Koj tsuas tau muab tej no tuaj ib zaug nkaus

xwb – thaum koj tuaj thov thawj zaug lossis thaum koj rov

Yog koj muab tsis tau koj cov puavpheej tuaj tabsis koj

tuaj txuas ntaub ntawv thov ntxiv xwb.

muaj lwm yam raws li luag tus qauv thiab muab lwm yam

rau luag tas lawm koj cov ntawv khomob yuav raug hloov

los ua cov kho tau qee yam lawm xwb. Qee yam ntawd yog

Tsab kevcai no puas hais txog kuv cov Food Stamps,

kev khomob xwmtxheej ceev, kho kev xeebtub, thiab kev

CalWORKs, lossis Healthy Families?

kho mus ntev.

Tsis hais txog. Cov kev yuav tau muab puavpheej uas qhia

tias yog neeg Amelikas thiab yog leejtwg tiag no tsuas yog

Koj muab tej puavpheej ntawd tuaj tsis dhau li ib xyoos

hais txog Medi-Cal nkaus xwb.

tomqab uas koj rov tuaj txuas ntaub ntawv thov, luag yuav

muab koj cov Medi-Cal hloov mus ua cov uas kho tau txhua

yam suav txij lub hlis uas koj cov ntawv khomob tau hloov

Nej puas yuavtsum tau daim ntawv qhia tias yog neeg

mus ua cov uas kho tau qee yam lawm xwb.

Amelikas thiab yog leejtwg tias uas yog daim tseem?

Yog koj muaj kev khomob thaum lub sijhawm uas koj

Yuavtsum tau. Peb yuavtsum tau daim ntawv qhia tias yog

tabtom nrhiav cov ntaub ntawv uas qhia tias koj yog

neeg Amelikas thiab yog leejtwg tias uas yog daim tseem,

neeg Amelikas thiab yog leejtwg tiag, tej zaum Medi-Cal

lossis cov ntawv luam uas lub koomhaum uas ua daim

yuav kam them rau koj cov nqi khomob. Hu mus rau lub

ntawv ntawd nias lawv lub thwj rau tias yog daim tseem.

Chaw Them Nqi Khomob hauv lub Department of Health

Care Services mus nrhiav lus teb rau koj cov lus nug:

Kuv xa kuv cov ntawv puavpheej tuaj puas tau?

(916) 403-2007.

Tau. Lub county yuav muab luam cia thiab muab daim

tseem xa rov tuaj rau koj. Lossis, koj nqa tau koj cov ntaub

Cov menyuam yaus puas tau muab cov puavpheej uas

ntawv mus rau tom lub chaw pabcuam pejxeem hauv koj

qhia tias lawv yog neeg Amelikas thiab yog leejtwg

lub nroog. Hais kom lawv muab luam thiab muab cov tseem

tiag, thiab?

rov rau koj tamsim.

Tau. Yog koj tus menyuam yug hauv xeev Kalifonias, hais

kom koj lub county pab yuav nws daim ntawv yug los ua

puavpheej qhia tias nws yog neeg Amelikas. Koj tseem

yuav tau muab tej puavpheej uas qhia tias koj yog leejtwg

tiag. Xyuas nplooj 3.

Yog koj tus menyuam tsis tau muaj 16 xyoo thiab koj tau ua

thiab suam npe rau daim ntawv thov Medi-Cal lossis thov

Healthy Families/Medi-Cal uake uas teev tus menyuam

ntawd hnub yug thiab chaw yug lawm, koj yuav tsis tau

muab tej puavpheej uas qhia tias nws yog leejtwg ntxiv

lawm. (Daim ntawv thov uas koj suam npe rau no yog

puavpheej uas qhia tau tias koj tus menyuam yog leejtwg

lawm.) Koj tseem yuav tau muab tej puavpheej uas qhia

tias nws yog neeg Amelikas.

Yog koj tus menyuam muaj hnub 16 xyoo lossis tshaj ntawd

lawm, koj yuav tau muab puavpheej uas qhia tias nws yog

leejtwg tiag. Xyuas nplooj 3.

DHCS 0002 (01/08) – Hmong

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Form Dhcs 0002 - Proof Of Citizenship And Identity (Hmong) - Health And Human Services Agency Page 2

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