The CCFRM604 is California's Single Streamlined Application, the official document used to apply for Medi-Cal and Covered California health insurance plans. California residents who need affordable health coverage for themselves or their families complete this form to determine program eligibility and enroll in state-sponsored health coverage.
This 36-page document collects key household and financial details, including income information, household size, immigration status, and current insurance coverage. Accurate completion of all 150 fillable fields helps ensure your application is processed quickly without requests for additional documentation. The form is available in multiple languages, including Spanish and Korean, to serve California's diverse communities.
Residents applying for health coverage may also find these related documents helpful: a standard health insurance application, a health insurance renewal form, or our general medical application form for supplementary guidance.
| Question | Answer |
|---|---|
| Form Name | Ccfrm604 |
| Form Length | 36 pages |
| Fillable? | Yes |
| Fillable fields | 150 |
| Avg. time to fill out | 39 min |
| Other names | ccfrm 604 form, ccfrm604 form, ccfrm 604, fillable ccfrm 604 |
