Access Ny Supplement A Form PDF Details

In the landscape of healthcare and social support, the Access NY Supplement A form stands as a crucial document for residents of New York State navigating the complexities of Medicaid eligibility, particularly for those with chronic illnesses or disabilities. This form, serving as an addendum to the main Access NY Health Care application, plays a significant role for individuals who require long-term care services, either in their homes or within a facility. It asks for detailed information about one’s medical condition, financial status, and other personal details to accurately assess eligibility for Medicaid coverage under the Medicaid Buy-In program for Working People with Disabilities (MBI-WPD). The MBI-WPD program is designed to help those who are working, have a disability, and are between the ages of 16 and 64, allowing them to earn more without losing vital health coverage. Essaying the path for individuals with chronic illnesses—defined as those unable to work for at least 12 months due to a health condition, or having an illness/disabling impairment expected to last for a year or more—the form underpins New York State’s commitment to ensuring access to necessary medical services without the undue financial burden, marking a significant stride towards inclusive healthcare provisioning.

QuestionAnswer
Form NameAccess Ny Supplement A Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesaccess ny, access ny supplement a, doh 4495a spanish version, supplement a form medicaid

Form Preview Example

Vxxzィィ5cn5hェ・・。z「z」ゥ5V5

i}~ィ5hェ・・。z「z」ゥ5「ェィゥ5wz5x、「・。zゥzy5~{5v」ョ、」z5ャ}、5~ィ5v・・。ョ~」|5~ィO5

ル5 5V|z5KJ5、ァ5、。yzァ5

ル5 5Xzァゥ~ᅭzy5w。~」y5、ァ5xzァゥ~ᅭzy5y~ィvw。zy5=、{5v」ョ5v|z>5

ル5 5c、ゥ5xzァゥ~ᅭzy5y~ィvw。zy5wェゥ5x}ァ、」~xv。。ョ5~。。5

ル5 ^5」ィゥ~ゥェゥ~、」v。~ッzy5v」y5v・・。ョ~」|5{、ァ5x、ォzァv|z5、{5」ェァィ~」|5}、「z5xvァzC5

i}~ィ5~」x。ェyzィ5xvァz5~」5v5}、ィ・~ゥv。5ゥ}vゥ5~ィ5zヲェ~ォv。z」ゥ5ゥ、5」ェァィ~」|5}、「z5xvァz

c、ゥzO5^{5ョ、ェ5vァz5v・・。ョ~」|5{、ァ5ゥ}z5bzy~xvァz5hvォ~」|ィ5eァ、|ァv「5=bhe>5、」。ョA5ゥ}~ィ5hェ・・。z「z」ゥ5y、zィ5」、ゥ5」zzy5ゥ、5wz5x、「・。zゥzyC5

^chigjXi^dchO5

ル5 5hzxゥ~、」ィ5V5ゥ}ァ、ェ|}5[5「ェィゥ5wz5x、「・。zゥzy5v」y5ゥ}~ィ5hェ・・。z「z」ゥ5「ェィゥ5wz5ィ~|」zyC5

ル5 5^{5ョ、ェ5、ァ5v」ョ、」z5~」5ョ、ェァ5}、ェィz}、。y5~ィ5v・・。ョ~」|5{、ァ5x、ォzァv|z5、{5」ェァィ~」|5}、「z5xvァzA5ョ、ェ5「ェィゥ55 v。ィ、5x、「・。zゥz5ィzxゥ~、」ィ5\5ゥ}ァ、ェ|}5^C

VC5i}~ィ5hェ・・。z「z」ゥ5~ィ5wz~」|5x、「・。zゥzy5{、ァO5

az|v。5avィゥ5cv「z

az|v。5[~ァィゥ5cv「z

b^

h、x~v。5hzxェァ~ゥョ5cェ「wzァ

bvァ~ゥv。5hゥvゥェィ

c、ゥzO5i}z5ァz「v~」~」|5ヲェzィゥ~、」ィ5vァz5{、ァ5ゥ}z5・zァィ、」=ィ>5」v「zy5vw、ォzC

WC5W。~」yA5Y~ィvw。zy5、ァ5X}ァ、」~xv。。ョ5^。。5

FC5V5ァz5ョ、ェ5x}ァ、」~xv。。ョ5~。。T5

55

 

5nzィ5

 

5c、5

(Examples of chronically ill would be unable to work for at least 12 months because of an illness or injury, or having an illness or disabling impairment that has lasted or is expected to last for 12 months.)

GC5V5ァz5ョ、ェ5Xzァゥ~ᅭzy5W。~」y5wョ5ゥ}z5X、「「~ィィ~、」5{、ァ5ゥ}z5W。~」y5v」y5k~ィェv。。ョ5]v」y~xv・・zyT5

 

 

 

=^{5ョzィA5ィz」y5・ァ、、{C>5

5nzィ5 5c、5

HC5^5{5ョ、ェ5vァz5y~ィvw。zy5v」y5ャ、ァ⦆~」|A5vァz5ョ、ェ5~」ゥzァzィゥzy5~」5v・・。ョ~」|5{、ァ5ゥ}z55

 

 

 

bW^BleY5・ァ、|ァv「T5

5nzィ5 5c、5

The Medicaid Buy-In program for Working People with Disabilities (MBI-WPD) offers Medicaid coverage to people who are disabled, working, and at least 16 years old but not yet 65 years old. The program allows higher income levels than the regular Medicaid program so working people with disabilities can earn more and keep their Medicaid coverage.

XC5Vァz5ョ、ェ5。~ォ~」|5~」5v」5vyェ。ゥ5}、「z5、ァ5vィィ~ィゥzy5。~ォ~」|5{vx~。~ゥョT5

5nzィ5 5c、

Yd]5B5IINJV5GDFE55=・v|z5F5、{55K>5

cnh5Yd]

YC5gzィ、ェァxzィDVィィzゥィ5=x}zx⦆5ゥ}z5w、ュ5ゥ}vゥ5v・・。~zィ>O5

555、ェ5vァz5v・・。ョ~」|5{、ァ5bzy~xv~y5x、ォzァv|z5wェゥ5」、ゥ5x、ォzァv|z5、{5x、「「ェ」~ゥョBwvィzy5。、」|Bゥzァ「5xvァz5ィzァォ~xzィC5 n、ェ5「vョ5vゥゥzィゥ5ゥ、5ゥ}z5v「、ェ」ゥ5、{5ョ、ェァ5ァzィ、ェァxzィC5n、ェ5vァz5」、ゥ5ァzヲェ~ァzy5ゥ、5ィェw「~ゥ5y、xェ「z」ゥvゥ~、」5、{5ョ、ェァ5 ァzィ、ェァxzィC5i}~ィ5x、ォzァv|z5y、zィ5」、ゥ5~」x。ェyz5」ェァィ~」|5}、「z5xvァzA5}、「z5xvァz5、ァ5v」ョ5、{5ゥ}z5x、「「ェ」~ゥョBwvィzy5 。、」|Bゥzァ「5xvァz5ィzァォ~xzィ5。~ィゥzy5wz。、ャC?5

555n5 、ェ5vァz5v・・。ョ~」|5{、ァ5x、ォzァv|z5、{5x、「「ェ」~ゥョBwvィzy5。、」|Bゥzァ「5xvァz5ィzァォ~xzィC5n、ェ5「ェィゥ5ィェw「~ゥ55 y、xェ「z」ゥvゥ~、」5、{5ゥ}z5xェァァz」ゥ5v「、ェ」ゥ5、{5ョ、ェァ5ァzィ、ェァxzィC?5i}zィz5ィzァォ~xzィ5~」x。ェyzO

ル55Vyェ。ゥ5yvョ5}zv。ゥ}5xvァz

ル55Xzァゥ~ᅭzy5]、「z5]zv。ゥ}5V|z」xョ5ィzァォ~xzィ

ル55a~「~ゥzy5。~xz」ィzy5}、「z5xvァz

ル55gzィ~yz」ゥ~v。5ゥァzvゥ「z」ゥ5{vx~。~ゥョ5xvァz

ル55eァ~ォvゥz5yェゥョ5」ェァィ~」|

ル55ezァィ、」v。5z「zァ|z」xョ5ァzィ・、」ィz5ィzァォ~xzィ

ル55]、ィ・~xz5~」5ゥ}z5x、「「ェ」~ゥョ

ル55ezァィ、」v。5xvァz5ィzァォ~xzィ

ル55]、ィ・~xz5ァzィ~yz」xz5・ァ、|ァv「

ル55bv」v|zy5。、」|Bゥzァ「5xvァz5~」5ゥ}z5x、「「ェ」~ゥョ

ル55Vィィ~ィゥzy5。~ォ~」|5・ァ、|ァv「

ル55l5v~ォzァ5v」y5、ゥ}zァ5ィzァォ~xzィ5・ァ、ォ~yzy5ゥ}ァ、ェ|}55

ル55X5、」ィェ「zァ5y~ァzxゥzy5・zァィ、」v。5vィィ~ィゥv」xz5・ァ、|ァv「

v5}、「z5v」y5x、「「ェ」~ゥョBwvィzy5ャv~ォzァ5・ァ、|ァv「

c、ゥzO5h、「z5zュv「・。zィ5、{5}、「z5v」y5x、「「ェ」~ゥョBwvィzy5・ァ、|ァv「ィ5ゥ}vゥ5・ァ、ォ~yz5ャv~ォzァィ5v」y5、ゥ}zァ5ィzァォ~xzィ55 vァz5iァvェ「vゥ~x5Wァv~」5^」⦅ェァョ5eァ、|ァv「5v」y5a、」|5izァ「5]、「z5]zv。ゥ}5Xvァz5eァ、|ァv「C5

555、ェ5vァz5~」ィゥ~ゥェゥ~、」v。~ッzy5v」y5v・・。ョ~」|5{、ァ5x、ォzァv|z5、{5」ェァィ~」|5}、「z5xvァzC5n、ェ5「ェィゥ5ィェw「~ゥ55

y、xェ「z」ゥvゥ~、」5、{5ョ、ェァ5ァzィ、ェァxzィ5wvx⦆5ゥ、5[zwァェvァョ5FA5GEEKA5、ァ5ゥ}z5・vィゥ5KE5「、」ゥ}ィA5ャ}~x}zォzァ5~ィ5。zィィC

5 5 ?、ェ5「vョ5wz5z。~|~w。z5{、ァ5ィ}、ァゥBゥzァ「5ァz}vw~。~ゥvゥ~、」5ィzァォ~xzィC5h}、ァゥBゥzァ「5ァz}vw~。~ゥvゥ~、」5ィzァォ~xzィ5~」x。ェyz5、」z55 x、「「z」xz「z」ゥDvy「~ィィ~、」5~」5v5FGB「、」ゥ}5・zァ~、y5、{5ェ・5ゥ、5GN5x、」ィzxェゥ~ォz5yvョィ5、{5」ェァィ~」|5}、「z5xvァz5

v」yD、ァ5xzァゥ~ᅭzy5}、「z5}zv。ゥ}5xvァzC

a~ィゥ5v。。5ァzィ、ェァxzィ5、ャ」zy5wョ5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィzD・vァz」ゥ=ィ>A5~」x。ェy~」|5xェィゥ、y~v。5vxx、ェ」ゥィC5^{5v・・。ョ~」|5{、ァ5

x、ォzァv|z5、{5」ェァィ~」|5}、「z5xvァzA5v。ィ、5。~ィゥ5v」ョ5vxx、ェ」ゥィ5x。、ィzy5ィ~」xz5[zwァェvァョ5FA5GEEKA5、ァ5~」5ゥ}z5・vィゥ5KE5「、」ゥ}ィA5 ャ}~x}zォzァ5・zァ~、y5~ィ5ィ}、ァゥzァP5~」x。ェyz5wv。v」xz5vゥ5x。、ィ~」|5v」y5・ァ、ォ~yz5v」5zュ・。v」vゥ~、」5、{5ャ}zァz5ゥ}z5wv。v」xz5ャvィ55 ゥァv」ィ{zァァzy5ゥ、5、ァ5}、ャ5~ゥ5ャvィ5ィ・z」ゥC5d」5v5ィz・vァvゥz5ィ}zzゥ5、{5・v・zァA5・ァ、ォ~yz5v」5zュ・。v」vゥ~、」5、{5zvx}5ゥァv」ィvxゥ~、」5、{55

9GAEEE5、ァ5「、ァzC5c、ゥzO5bzy~xv~y5ァzゥv~」ィ5ゥ}z5ァ~|}ゥ5ゥ、5ァzォ~zャ5v。。5ゥァv」ィvxゥ~、」ィ5「vyz5yェァ~」|5ゥ}z5ゥァv」ィ{zァ5。、、⦆Bwvx⦆5・zァ~、yC

FC5X}zx⦆~」|Dhvォ~」|ィDXァzy~ゥ5j」~、」5Vxx、ェ」ゥィDXzァゥ~ᅭxvゥzィ5、{5Yz・、ィ~ゥィ5=XYィ>O5

Wv」⦆5cv「z5v」y55

 

Xェァァz」ゥ5Y、。。vァ5

X。、ィzy5Vxx、ェ」ゥ5Wv。v」xzD

Vxx、ェ」ゥ5cェ「wzァ

cv「z5、{5dャ」zァ=ィ>

V「、ェ」ゥ

Yvゥz5X。、ィzy

 

 

 

 

 

 

 

 

 

 

GC5gzゥ~ァz「z」ゥ5Vxx、ェ」ゥィ5=Yz{zァァzy5X、「・z」ィvゥ~、」A5^gV5v」yD、ァ5`z、|}>O5

 

 

 

Xェァァz」ゥ5Y、。。vァ5

 

 

Vxx、ェ」ゥ5cェ「wzァ

cv「z5、{5dャ」zァ=ィ>

iョ・zD^」ィゥ~ゥェゥ~、」

V「、ェ」ゥ

evョ5dェゥ

 

 

 

 

55nzィ555555

55c、

 

 

 

55nzィ555555

55c、

 

 

 

55nzィ555555

55c、

 

 

 

55nzィ555555

55c、

Yd]5B5IINJV55GDFE55=・v|z5G5、{55K>

cnh5Yd]

HC5a~{z5^」ィェァv」xz5e、。~x~zィO5

^」ィェァv」xz5X、「・v」ョ

e、。~xョ5cェ「wzァ

cv「z5、{5dャ」zァ=ィ>

Xvィ}5kv。ェz

[vxz5kv。ェz

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IC5V」」ェ~ゥ~zィA5hゥ、x⦆ィA5W、」yィA5bェゥェv。5[ェ」yィO5

cv「z5、{5dャ」zァ=ィ>

X、「・v」ョ

Yvゥz5eェァx}vィzy

kv。ェz

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JC5i5ァェィゥ5Vxx、ェ」ゥィO5^{5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz5xァzvゥzy5、ァ5vァz5ゥ}z5wz」zᅭx~vァョ5、{5v5ゥァェィゥA5ィェw「~ゥ5v5x、・ョ5、{5ゥ}z5ゥァェィゥA55 ~」x。ェy~」|5ゥ}z5ィx}zyェ。z5、{5ゥァェィゥ5vィィzゥィC5

cv「z5、{5iァェィゥ

\ァv」ゥ、ァ

iァェィゥzz=ィ>

Vィィzゥィ

Wz」zᅭx~vァョ

^」x、「z

 

 

 

 

 

 

 

 

 

 

 

 

KC5Wェァ~v。5VィィzゥィDWェァ~v。5X、」ゥァvxゥィO5=^」x。ェyz5x、・~zィ>5

Y、5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz5}vォz5v5・ァzB・v~y5{ェ」zァv。5v|ァzz「z」ゥ5{、ァ5ョ、ェ5、ァ5v」ョ、」z5z。ィz5~」5ョ、ェァ5{v「~。ョT555555

55nzィ55555

55c、

Y、5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz5}vォz5v5wェァ~v。5ィ・vxz5、ァ5・。、ゥ5{、ァ5ョ、ェ5、ァ5v」ョ、」z5z。ィz5~」5ョ、ェァ5{v「~。ョT5555555555555555555555

55nzィ55555

55c、

Y、5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz5}vォz5「、」zョ5~」5v5wv」⦆5vxx、ェ」ゥ5ィzゥ5vィ~yz5{、ァ5v5wェァ~v。5{ェ」yT555555555555555555555555555555555555

55nzィ55555

55c、

55555^{5ョzィA5~」5ャ}vゥ5vxx、ェ」ゥ=ィ>5~ィ5ョ、ェァ5v」yD、ァ5ョ、ェァ5ィ・、ェィz￉ィ5wェァ~v。5{ェ」yT

 

 

 

Wv」⦆5cv「z5v」y5Vxx、ェ」ゥ5cェ「wzァ

cv「z5、{5dャ」zァ=ィ>

kv。ェz

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y、5ョ、ェ5}vォz5。~{z5~」ィェァv」xz5ゥ、5wz5ェィzy5vィ5ョ、ェァ5wェァ~v。5{ェ」yT555555555555555555555555555555555555555555555555555555555555555555555555555555555555555

55nzィ55555

55c、

55555^{5ョzィA5ャ}vゥ5~ィ5ョ、ェァ5・、。~xョ5」ェ「wzァ=ィ>T

 

 

 

 

55555^{5ョzィA5~ィ5ゥ}z5{ェ。。5xvィ}5ォv。ェz5ゥ、5wz5ェィzy5{、ァ5ョ、ェァ5wェァ~v。5zュ・z」ィzィT5555555555555555555555555555555555555555555555555555555555555555555555555

55nzィ55555

55c、

Y、zィ5ョ、ェァ5ィ・、ェィz5}vォz5。~{z5~」ィェァv」xz5ゥ、5wz5ェィzy5vィ5v5wェァ~v。5{ェ」yT5

5555555555555555555555555

55nzィ55555

55c、5

55555^{5ョzィA5ャ}vゥ5~ィ5ゥ}z5・、。~xョ5」ェ「wzァ=ィ>T

 

 

 

 

55555^{5ョzィA5~ィ5ゥ}z5{ェ。。5xvィ}5ォv。ェz5ゥ、5wz5ェィzy5{、ァ5wェァ~v。5zュ・z」ィzィT

5555555555555555555555555

55nzィ55555

 

 

 

55c、

LC5k5z}~x。z=ィ>O5a~ィゥ5v。。5xvァィA5ゥァェx⦆ィ5v」y5ォv」ィC5a~ィゥ5v。。5ァzxァzvゥ~、」v。5ォz}~x。zィA5~」x。ェy~」|5xv「・zァィA5ィ」、ャ「、w~。zィA5w、vゥィ55 v」y5「、ゥ、ァxョx。zィC5

cv「z5、{5dャ」zァ=ィ>

nzvァDbv⦆zDb、yz。

[v~ァBbvァ⦆zゥ5kv。ェz

V「、ェ」ゥ5dャzy

^」5jィzT

 

 

 

 

55nzィ5555

55c、

 

 

 

55nzィ5555

55c、

 

 

 

55nzィ5555

55c、

 

 

 

55nzィ5555

55c、

 

 

 

55nzィ5555

55c、

 

 

 

55nzィ5555

55c、

Yd]5B5IINJV55GDFE55=・v|z5H5、{55K>

cnh5Yd]

MC5Zヲェ~ゥョ5kv。ェz5~」5]、「zO5

^{5ョ、ェ5、ャ」5ョ、ェァ5}、「zA5ャ}vゥ5~ィ5ゥ}z5zヲェ~ゥョ5ォv。ェz5~」5ョ、ェァ5}、「zT559

c、ゥzO5Zヲェ~ゥョ5ォv。ェz5~ィ5ゥ}z5{v~ァ5「vァ⦆zゥ5ォv。ェz5。zィィ5v」ョ5、ェゥィゥv」y~」|5。~z」ィA5「、ァゥ|v|zィA5zゥxC

NC5a~ィゥ5V」ョ5dゥ}zァ5gzィ、ェァxzィO5

gzィ、ェァxz5iョ・z

 

cv「z5、{5dャ」zァ=ィ>

 

 

kv。ェz

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ZC5gzv。5eァ、・zァゥョ5=、ゥ}zァ5ゥ}v」5ョ、ェァ5}、「z>5

 

 

 

 

 

 

 

 

 

 

Y、5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz5、ャ」5、ァ5}vォz5v5。z|v。5~」ゥzァzィゥ5~」5v」ョ5、ゥ}zァ5ァzv。5・ァ、・zァゥョT5=X}zx⦆5v」ョ5ゥ}vゥ5v・・。ョ>55555

55nzィ5555

55c、

 

 

 

 

 

 

 

 

5g5z」ゥv。5

5kvxvゥ~、」5eァ、・zァゥョ

5i~「z5h}vァz

5k5vxv」ゥ5

 

5d5ゥ}zァ5eァ、・zァゥョ5

 

 

eァ、・zァゥョ

 

 

 

av」y

 

g~|}ゥィ5=^」5、ァ5、ェゥィ~yz5

 

 

 

 

 

 

、{5czャ5n、ァ⦆5hゥvゥz>

 

^{5ョzィA5・。zvィz5v」ィャzァ5ゥ}z5{、。。、ャ~」|5ヲェzィゥ~、」ィO

cv「z5v」y5Vyyァzィィ5、{5dャ」zァ=ィ>

Vyyァzィィ5、{5eァ、・zァゥョ

iョ・z5、{5dャ」zァィ}~・5=X}zx⦆5、」z>

 

Zヲェ~ゥョ5ォv。ェz

 

 

5^」y~ォ~yェv。55555

5_、~」ゥ5ゥz」v」xョ5555

5a~{z5zィゥvゥz

 

 

5^」y~ォ~yェv。55555

5_、~」ゥ5ゥz」v」xョ5555

5a~{z5zィゥvゥz

 

 

5^」y~ォ~yェv。55555

5_、~」ゥ5ゥz」v」xョ5555

5a~{z5zィゥvゥz

 

 

5^」y~ォ~yェv。55555

5_、~」ゥ5ゥz」v」xョ5555

5a~{z5zィゥvゥz

[C5]、「zィゥzvy5

55555FC5Y、5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz5、ャ」5、ァ5}vォz5v5。z|v。5~」ゥzァzィゥ5~」5ョ、ェァ5}、「zA5~」x。ェy~」|5v5。~{z5zィゥvゥzT555555555555nzィ5555555c、

55555GC5^{5ョ、ェ5vァz5~」5v5「zy~xv。5{vx~。~ゥョ5v」y5、ャ」5ョ、ェァ5}、「zA5y、5ョ、ェ5~」ゥz」y5ゥ、5ァzゥェァ」5ゥ、5ョ、ェァ5}、「zT5555555555555555555nzィ5555555c、

55555HC5^5{5」、A5~ィ5v」ョ、」z5。~ォ~」|5~」5ゥ}z5}、「zT555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555nzィ5555555c、

555555555l}、5~ィ5。~ォ~」|5~」5ゥ}z5}、「zT

555555555]、ャ5~ィ5ゥ}~ィ5・zァィ、」5ァz。vゥzy5ゥ、5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィzT

5555555555^{5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz￉ィ5x}~。y5=、{5v」ョ5v|z>5~ィ5。~ォ~」|5~」5ゥ}z5}、「zA5~ィ5ゥ}z5x}~。y5y~ィvw。zyT55555555555555555555nzィ5555555c、

55555c5、ゥzO5^{5ゥ}zァz5~ィ5v5。z|v。5~「・zy~「z」ゥ5ゥ}vゥ5・ァzォz」ゥィ5ョ、ェ5{ァ、「5ィz。。~」|5ゥ}~ィ5・ァ、・zァゥョA5ゥ}z5・ァ、・zァゥョ55 ~ィ5」、ゥ5x、ェ」ゥzy5~」5yzゥzァ「~」~」|5bzy~xv~y5z。~|~w~。~ゥョC5

hide5]ZgZ5ェ」。zィィ5ョ、ェ5、ァ5v」ョ、」z5~」5ョ、ェァ5}、ェィz}、。y5~ィ5~」ィゥ~ゥェゥ~、」v。~ッzy5v」y5v・・。ョ~」|5{、ァ5x、ォzァv|z5、{5」ェァィ~」|5 }、「z5xvァzC5]、ャzォzァA5ゥ}z5。vィゥ5・v|z5、{5ゥ}~ィ5y、xェ「z」ゥ5bjhi5wz5ィ~|」zyC5

Yd]5B5IINJV55GDFE55=・v|z5I5、{55K>

cnh5Yd]

\C5V・・。~xv」ゥ5a~ォ~」|5~」5v5a、」|Bizァ「5Xvァz5[vx~。~ゥョDcェァィ~」|5]、「z5

cv「z5、{5[vx~。~ゥョ

Yvゥz5Vy「~ゥゥzy5

iz。z・}、」z5cェ「wzァ5

 

 

555555555555D555555555555555D

=555555555555555>

 

 

 

 

 

hゥァzzゥ5Vyyァzィィ

X~ゥョ

hゥvゥz

o~・

 

 

 

 

V・・。~xv」ゥ￉ィ5eァzォ~、ェィ5Vyyァzィィ

X~ゥョ

hゥvゥz

o~・

 

 

 

 

]C5Vィィzゥ5iァv」ィ{zァィ5

55555FC5iァv」ィ{zァィ

55555555555vC5Y5~y5ョ、ェA5ョ、ェァ5ィ・、ェィzA5、ァ5ィ、「z、」z5、」5ョ、ェァ5wz}v。{5ゥァv」ィ{zァA5x}v」|z5、ャ」zァィ}~・5~」A5

 

 

 

 

 

 

 

 

 

|~ォz5vャvョA5、ァ5ィz。。5v」ョ5vィィzゥィA5~」x。ェy~」|5ョ、ェァ5}、「z5、ァ5、ゥ}zァ5ァzv。5・ァ、・zァゥョT

5555555555555555555555555

55nzィ55555

 

55c、

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55555555555wC5Vァz5ョ、ェ5~」5ゥ}z5・ァ、xzィィ5、{5ィz。。~」|5・ァ、・zァゥョT5

 

5555555555555555555555555

55nzィ55555

 

55c、

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55555555555xC5Y5~y5ョ、ェA5ョ、ェァ5ィ・、ェィz5、ァ5ィ、「z、」z5、」5ョ、ェァ5wz}v。{A5x}v」|z5ゥ}z5yzzy5、ァ5ゥ}z55

5555555555555555555555555

55nzィ55555

 

55c、

 

、ャ」zァィ}~・5、{5v」ョ5ァzv。5・ァ、・zァゥョA5~」x。ェy~」|5xァzvゥ~」|5v5。~{z5zィゥvゥzT55

 

 

 

 

 

 

 

 

 

^{5ョzィA5ャ}z」T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55555555555yC5^5{5ョ、ェ5・ェァx}vィzy5v5。~{z5zィゥvゥz5~」5v」、ゥ}zァ5・zァィ、」￉ィ5}、「zA5y~y5ョ、ェ5。~ォz5~」5ゥ}z55

 

 

 

 

 

 

 

 

 

}、「z5{、ァ5vゥ5。zvィゥ5、」z5ョzvァ5v{ゥzァ5ョ、ェ5・ェァx}vィzy5ゥ}z5。~{z5zィゥvゥzT555555555555555555555555555555555555555555555555555555555555555555

55nzィ55555

55c、

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55555555555zC5Y5~y5ョ、ェA5ョ、ェァ5ィ・、ェィzA5、ァ5ィ、「z、」z5、」5ョ、ェァ5wz}v。{5・ェァx}vィz5v5「、ァゥ|v|zA55

 

 

 

 

 

 

 

 

 

。、v」A5、ァ5・ァ、「~ィィ、ァョ5」、ゥzT55555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555

55nzィ55555

55c、5

 

^{5ョzィA5ャ}z」T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55555555555{C5Y5~y5ョ、ェA5ョ、ェァ5ィ・、ェィzA5、ァ5ィ、「z、」z5、」5ョ、ェァ5wz}v。{5・ェァx}vィz5、ァ5x}v」|z5v」5v」」ェ~ゥョT5555555555555555555555555555555

55nzィ55555

 

55c、5

 

^{5ョzィA5ャ}z」T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55555GC55^5」5ゥ}z5。vィゥ5KE5「、」ゥ}ィA5}vォz5ョ、ェ5、ァ5ョ、ェァ5ィ・、ェィz5xァzvゥzy5、ァ5ゥァv」ィ{zァァzy5v」ョ5vィィzゥィ55

 

 

 

 

 

 

 

 

 

~」ゥ、5、ァ5、ェゥ5、{5v5ゥァェィゥT55555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555

 

55nzィ55555

 

55c、

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55^5{5ョ、ェ5v」ィャzァzy5ョzィ5ゥ、5v」ョ5、{5ゥ}z5ヲェzィゥ~、」ィ5vw、ォzA5zュ・。v~」5ゥ}z5ゥァv」ィ{zァ=ィ>5wz。、ャC5

 

 

 

 

 

 

 

 

 

Vゥゥvx}5vyy~ゥ~、」v。5ィ}zzゥィ5、{5・v・zァA5~{5」zzyzyC5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yzィxァ~・ゥ~、」5、{5Vィィzゥ5=~」x。ェy~」|5~」x、「z>

Yvゥz5、{5iァv」ィ{zァ

iァv」ィ{zァァzy5ゥ、5l}、「

 

V「、ェ」ゥ5、{5iァv」ィ{zァ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

555HC5]5vォz5ョ、ェA5ョ、ェァ5ィ・、ェィzA5、ァ5ィ、「z、」z5vxゥ~」|5、」5ョ、ェァ5wz}v。{5|~ォz」5v5yz・、ィ~ゥ5ゥ、5v」ョ5}zv。ゥ}5xvァz5、ァ55

ァzィ~yz」ゥ~v。5{vx~。~ゥョA5ィェx}5vィ5v5」ェァィ~」|5}、「zA5vィィ~ィゥzy5。~ォ~」|5{vx~。~ゥョA5x、」ゥ~」ェ~」|5xvァz5ァzゥ~ァz「z」ゥ55

x、「「ェ」~ゥョ5、ァ5。~{z5xvァz5x、「「ェ」~ゥョT55^{5ョzィA5ィz」y5x、・ョ5、{5v|ァzz「z」ゥC55555555555555555555555555555555555555555555555555555555555

55nzィ55555

55c、

^C5ivュ5gzゥェァ」ィ5

Y~y5ョ、ェ5v」yD、ァ5ョ、ェァ5ィ・、ェィz5ᅭ。z5jChC5~」x、「z5ゥvュ5ァzゥェァ」ィ5~」5ゥ}z5。vィゥ5{、ェァ5ョzvァィT555555555555555555555555555555555555555555555555nzィ55555 ^{5ョzィA5ィz」y5x、・~zィ5、{5ゥ}zィz5ァzゥェァ」ィC5

55c、5

Yd]5B5IINJV55GDFE55=・v|z5J5、{55K>

cnh5Yd]

j・、」5ァzxz~・ゥ5、{5bzy~xv~yA5v5。~z」5「vョ5wz5ᅭ。zy5v」y5v5ァzx、ォzァョ5「vョ5wz5「vyz5v|v~」ィゥ5ョ、ェァ5ァzv。5・ァ、・zァゥョ5ェ」yzァ5xzァゥv~」55 x~ァxェ「ィゥv」xzィ5~{5ョ、ェ5vァz5~」5v5「zy~xv。5~」ィゥ~ゥェゥ~、」5v」y5」、ゥ5zュ・zxゥzy5ゥ、5ァzゥェァ」5}、「zC5bzy~xv~y5・v~y5、」5ョ、ェァ5wz}v。{5「vョ55 wz5ァzx、ォzァzy5{ァ、「5・zァィ、」ィ5ャ}、5}vy5。z|v。5ァzィ・、」ィ~w~。~ゥョ5{、ァ5ョ、ェァ5ィェ・・、ァゥ5vゥ5ゥ}z5ゥ~「z5「zy~xv。5ィzァォ~xzィ5ャzァz5、wゥv~」zyC55 bzy~xv~y5「vョ5v。ィ、5ァzx、ォzァ5ゥ}z5x、ィゥ5、{5ィzァォ~xzィ5v」y5・ァz「~ェ「ィ5~」x、ァァzxゥ。ョ5・v~yC5

[zyzァv。5v」y5hゥvゥz5。vャィ5・ァ、ォ~yz5ゥ}vゥ5v」ョ5ゥァv」ィ{zァ5、{5vィィzゥィ5{、ァ5。zィィ5ゥ}v」5{v~ァ5「vァ⦆zゥ5ォv。ェz5「vyz5wョ5v」5~」y~ォ~yェv。5、ァ5v」55 ~」y~ォ~yェv。￉ィ5ィ・、ェィzA5ャ~ゥ}~」5ゥ}z5ゥァv」ィ{zァ5、{5vィィzゥィ5。、、⦆Bwvx⦆5・zァ~、y5=、ァ5KE5「、」ゥ}ィ5~」5ゥ}z5xvィz5、{5ゥァェィゥBァz。vゥzy5ゥァv」ィ{zァィ>5 ・ァ~、ァ5ゥ、5ゥ}z5ᅭァィゥ5、{5ゥ}z5「、」ゥ}5~」5ャ}~x}5ゥ}z5~」y~ォ~yェv。5~ィ5w、ゥ}5~」5ァzxz~・ゥ5、{5」ェァィ~」|5{vx~。~ゥョ5ィzァォ~xzィ5v」y5yzゥzァ「~」zy55

、ゥ}zァャ~ィz5z。~|~w。z5{、ァ5bzy~xv~y5x、ォzァv|z5、{5」ェァィ~」|5{vx~。~ゥョ5ィzァォ~xzィA5「vョ5xvェィz5ゥ}z5~」y~ォ~yェv。5ゥ、5wz5~」z。~|~w。z5{、ァ55 」ェァィ~」|5{vx~。~ゥョ5ィzァォ~xzィ5{、ァ5v5・zァ~、y5、{5ゥ~「zC5

Vィ5v5x、」y~ゥ~、」5、{5bzy~xv~y5x、ォzァv|z5{、ァ5」ェァィ~」|5{vx~。~ゥョ5ィzァォ~xzィA5v・・。~xv」ゥィ5vァz5ァzヲェ~ァzy5ゥ、5y~ィx。、ィz5v5yzィxァ~・ゥ~、」55 、{5v」ョ5~」ゥzァzィゥ5ゥ}z5~」y~ォ~yェv。5、ァ5ゥ}z5~」y~ォ~yェv。￉ィ5ィ・、ェィz5}vィ5~」5v」5v」」ェ~ゥョC5i}~ィ5y~ィx。、ィェァz5~ィ5ァzヲェ~ァzy5ァz|vァy。zィィ5、{5 ャ}zゥ}zァ5ゥ}z5v」」ェ~ゥョ5~ィ5~ァァzォ、xvw。z5、ァ5v5x、ェ」ゥvw。z5ァzィ、ェァxzC5

^」5vyy~ゥ~、」5ゥ、5ゥ}z5・ェァx}vィz5、{5v」5v」」ェ~ゥョA5xzァゥv~」5ゥァv」ィvxゥ~、」ィ5「vyz5ゥ、5v」5v」」ェ~ゥョ5wョ5ゥ}z5v・・。~xv」ゥ5、ァ5ゥ}z5v・・。~xv」ゥ￉ィ5 ィ・、ェィz5、」5、ァ5v{ゥzァ5[zwァェvァョ5MA5GEEKA5「vョ5wz5ゥァzvゥzy5vィ5v5ゥァv」ィ{zァ5ェ」。zィィO5

ル55i}z5hゥvゥz5~ィ5」v「zy5ゥ}z5ァz「v~」yzァ5wz」zᅭx~vァョ5~」5ゥ}z5ᅭァィゥ5・、ィ~ゥ~、」5{、ァ5vゥ5。zvィゥ5ゥ}z5v「、ェ」ゥ5、{5bzy~xv~y5・v~y55 、」5wz}v。{5、{5ゥ}z5v」」ェ~ゥv」ゥP5、ァ5

ル55i}z5hゥvゥz5~ィ5」v「zy5~」5ゥ}z5ィzx、」y5・、ィ~ゥ~、」5v{ゥzァ5v5x、「「ェ」~ゥョ5ィ・、ェィz5、ァ5「~」、ァ5、ァ5y~ィvw。zy5x}~。yA5、ァ5~」5ゥ}z5ᅭァィゥ55 ・、ィ~ゥ~、」5~{5ィェx}5ィ・、ェィz5、ァ5ァz・ァzィz」ゥvゥ~ォz5、{5ィェx}5x}~。y5y~ィ・、ィzィ5、{5v」ョ5ィェx}5ァz「v~」yzァ5{、ァ5。zィィ5ゥ}v」5{v~ァ55

「vァ⦆zゥ5ォv。ェzC5

^{5y、xェ「z」ゥvゥ~、」5~ィ5」、ゥ5ィェw「~ゥゥzy5ォzァ~{ョ~」|5ゥ}vゥ5ゥ}z5hゥvゥz5}vィ5wzz」5」v「zy5ァz「v~」yzァ5wz」zᅭx~vァョA5ョ、ェ5「vョ5wz55 ~」z。~|~w。z5{、ァ5x、ォzァv|z5、{5」ェァィ~」|5{vx~。~ゥョ5ィzァォ~xzィC5

^{5ゥ}z5v」」ェ~ゥョ5~ィ5v5x、ェ」ゥvw。z5ァzィ、ェァxz5vゥ5ゥ}z5ゥ~「z5、{5v・・。~xvゥ~、」A5ョ、ェDョ、ェァ5ィ・、ェィz5vァz5」、ゥ5ァzヲェ~ァzy5ゥ、5」v「z5ゥ}z5hゥvゥz55 vィ5ァz「v~」yzァ5wz」zᅭx~vァョC5

^5xzァゥ~{ョ5ェ」yzァ5・z」v。ゥョ5、{5・zァ⦅ェァョA5ゥ}vゥ5ゥ}z5~」{、ァ「vゥ~、」5、」5ゥ}~ィ5{、ァ「5~ィ5x、ァァzxゥ5v」y5x、「・。zゥz5ゥ、5ゥ}z5wzィゥ5、{5「ョ55 ⦆」、ャ。zy|zC5^5ェ」yzァィゥv」y5ゥ}vゥ5^5「ェィゥ5ァz・、ァゥ5v」ョ5x}v」|zィ5~」5ゥ}~ィ5~」{、ァ「vゥ~、」5ャ~ゥ}~」5FE5yvョィ5、{5ゥ}z5x}v」|zC5

m5

 

 

55555h^\cVijgZ5d[5Veea^XVciDgZegZhZciVi^kZ5

55555YViZ5h^\cZY

 

m5

 

 

55555h^\cVijgZ5d[5Veea^XVci￉h5hedjhZ5

55555YViZ5h^\cZY

 

Yd]5B5IINJV55GDFE55=・v|z5K5、{55K>

cnh5Yd]

How to Edit Access Ny Supplement A Form Online for Free

doh 4495a ny can be filled out easily. Just try FormsPal PDF editing tool to finish the job quickly. Our development team is always working to develop the editor and insure that it is even better for users with its extensive functions. Bring your experience to another level with constantly growing and exciting opportunities available today! Here's what you would want to do to start:

Step 1: Hit the "Get Form" button in the top part of this page to get into our PDF editor.

Step 2: With the help of this handy PDF editing tool, you're able to do more than merely complete blank form fields. Express yourself and make your forms appear great with customized textual content incorporated, or tweak the original content to perfection - all comes with the capability to insert any type of photos and sign it off.

For you to fill out this document, make sure that you type in the necessary details in every blank:

1. Whenever filling in the doh 4495a ny, make certain to include all of the necessary blanks within the corresponding part. It will help to speed up the work, allowing for your details to be processed quickly and properly.

doh 5147 completion process shown (stage 1)

2. Once your current task is complete, take the next step – fill out all of these fields - MANDATORY BIRT Estimated Payment, Total Due by Line plus Line , ESTIMATED PAYMENTS AND OTHER, and any credit from overpayment of, b Credit from Special Credit, c Total payments and credits Line, Net Tax Due Line less Line c, If Line c is greater than Line , Interest and Penalty, Refer to web site for current, TOTAL DUE including Interest and, Use payment coupon Make check, OVERPAYMENT OPTIONS If Line C is, b Applied to the Net Profits Tax, and c Applied to the Business Income with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

b Applied to the  Net Profits Tax,  Total Due by  Line  plus Line , and  Net Tax Due Line  less Line c of doh 5147

3. The third step is generally straightforward - fill out all the fields in Under penalties of perjury as set, Taxpayer Signature DatePhone , Preparer Signature DatePhone , BIRTEZ Page , and BIRTEZ P Fillable to complete this part.

doh 5147 completion process outlined (portion 3)

4. The subsequent section will require your details in the subsequent areas: BIRTEZ, TAX COMPUTATION SCHEDULES, City Account Number, If business is operated inside and, NET INCOME PORTION, Place X in box to indicate a loss, METHOD II Net Income or loss as, METHOD I Net Income or loss in, Statutory Net Income Deduction, Loss Carry Forward if any, Taxable Income or loss Amount on, TAX DUE Line X If Line is a, GROSS RECEIPTS PORTION, Do not report negative numbers for, and TAXABLE GROSS RECEIPTS from a. Make certain you fill out all of the required information to go forward.

Completing segment 4 of doh 5147

As for Loss Carry Forward if any and Place X in box to indicate a loss, be sure that you review things in this section. These are thought to be the key ones in the PDF.

5. Since you draw near to the final parts of the file, you will find several more points to do. Particularly, TAXABLE GROSS RECEIPTS from a, b Services, c Rentals of real property, d Royalties, e Gains on sales of capital, f Gains on sales of stocks bonds, g Dividends Not applicable to, h Interest Not applicable to, i Other Describe , TAXABLE GROSS RECEIPTS before, and Statutory Exclusion Lower of Line must all be filled in.

How you can fill out doh 5147 stage 5

Step 3: Before finishing the file, make sure that form fields have been filled out correctly. As soon as you are satisfied with it, click “Done." Try a free trial plan at FormsPal and get immediate access to doh 4495a ny - which you'll be able to then begin using as you want inside your FormsPal account. FormsPal is devoted to the confidentiality of all our users; we make sure all personal information entered into our editor remains protected.