Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-Cal Must Show Proof Of Citizenship And Identity (Hmong) - Health And Human Services Agency Page 4

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State of California – Health and Human Services Agency
Department of Health Care Services
Peb lossis ntau tshaj ntawd yam ntawv uas qhia tau tias muaj
Rau cov menyuam uas tsis tau muaj 16 xyoo uas tsis muaj daim
tseeb, xwsli daim ID ua haujlwm, high school lossis college
ntawv Qhia Tias Yog Neeg Amelikas, koj muab tau:
diplomas, ntawv sib yuav, ntawv sib nrauj, thiab ntaub ntawv tswv
Ib daim ntawv teev lus tseeb (Affidavit) tias tus menyuam ntawd
vajtse/av (deeds/titles)
yog leejtwg uas suamnpe rau los ntawm tus menyuam niamtxiv,
Ntaub ntawv los ntawm tsev kuaj mob, kws khomob, lossis tsev
tus saib xyuas, lossis tus txheebze uas tu nws uas teev nws lub
khomob rau ib tus menyuam uas tsis tau muaj 16 xyoo
hnub yug thiab chaw yug
Ntaub ntawv mus kawm ntawv, zov menyuam mos, lossis chaw
Ib daim ntawv thov Medi-Cal lossis ntawv thov Healthy
zov menyuam, nrog rau ntawv qhia qhab-nees (report cards), rau
Families/Medi-Cal uake uas muaj tus menyuam ntawd lub hnub
ib tus menyuam uas tsis tau muaj 16 xyoo. Lub county mam nug
yug thiab chaw yug, thiab suamnpe rau los ntawm tus menyuam
thiab nrog lub tsev kawm ntawv tham.
ntawd niamtxiv, tus saib xyuas lossis tus txheebze uas tu nws.
Rau cov tibneeg uas muaj teebmeem kev tu-ncua hauv lub cev
Rau ib tus menyuam uas tsis tau muaj 18 xyoo, siv tau ib daim
uas nyob hauv ib lub chaw tu tibneeg, ib daim ntawv teev lus
ntawv teev lus tseeb (Affidavit) tias tus menyuam ntawd yog leejtwg
tseeb (Affidavit) uas suamnpe rau los ntawm tus thawj tsavxwm
uas suamnpe rau los ntawm tus menyuam niamtxiv, tus saib xyuas,
lossis tus thawj saib lub chaw ntawd
lossis tus txheebze uas tu nws yog tias nws tsis muaj ID kawm ntawv
lossis laixees tsav tsheb.
Qhia: Cov I.D. uas tas sijhawm lawm los txais tau los ua puavpheej
qhia tias koj yog leejtwg.
DHCS 0001 (01/08) – Hmong
Page 4 of 4

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