Form Csf 01 8643 PDF Details

CSF 01 8643 is a form that can be used to apply for Medicaid. The form can be downloaded from the internet, and it must be filled out completely in order to qualify for Medicaid benefits. The form can be submitted either online or by mail, and the process of applying for Medicaid will vary depending on the state in which you reside. In order to find out if you are eligible for Medicaid benefits, you can use the CSF 01 8643 form to apply. You can download the form from the internet, and it must be completed in order to qualify for Medicaid benefits. The application process will vary depending on your state of residence, so it is important that you contact your local Medicaid office for more information. If you have any questions about filling out the CSF 01 8643 form, you should contact a qualified attorney or healthcare professional.

QuestionAnswer
Form NameForm Csf 01 8643
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdeskdoj, electronically, discriminate, OAR

Form Preview Example

Child Support Grievance Form

If you have a dispute with a child support office, please try to resolve the problem with staff, a leadworker or supervisors in that office before you file a grievance (formal complaint). Each local office should have a complaint process for you to use. The child support office cannot discriminate against you for filing a complaint or grievance.

If you believe you were treated unfairly or your support case was not handled appropriately and you are unable to resolve your complaint through your local office, report your complaint on this form. Send the completed form to: Constituent Services, Oregon Child Support Program, 1162 Court Street NE, Salem, OR 97301.

Your name:

 

Daytime Phone:

 

 

Case Name (if different)

 

Child Support Case Number:

 

Address:

 

 

 

 

 

 

 

(Street)

 

 

 

 

 

 

 

 

(City)

(State)

(Zip Code)

PLEASE READ THIS PART BEFORE FILING A GRIEVANCE:

The Oregon Child Support Program must follow the requirements of federal and state laws when deciding and taking actions. We realize that sometimes people do not agree with these actions or decisions. However, if your complaint is about an action the law says we must do or can do, we cannot continue with your grievance using this formal process. We will keep working with you to resolve the issue(s). Some examples of issues we cannot address using this formal process include child support order amounts, income withholding as required by law, and actions taken by other agencies or states. For more specific information, see OAR 137-055-1600.

Oregon Child Support office you want to report:

Describe your complaint here. Be sure to sign and date the form on the next page.

Page 1 of 2 CHILD SUPPORT GRIEVANCE FORM CSF 01 8643 web (Rev. 11/18/20)

Signed:

 

Date:

English

Need another language? Contact us.

French

Avez-vous besoin d’une autre langue? Communiquez avec nous.

German

Sie benötigen eine andere Sprache? Kontaktieren Sie uns.

 

 

Russian

Предпочитаете другой язык? Свяжитесь с нами.

Somali

Ma u baahan tahay luqad kale? Na la soo xiriir.

 

 

Spanish

¿Necesita otro idioma? Contáctenos.

Vietnamese

Quý vị có cần dùng ngôn ngữ khác không? Hãy liên lạc với chúng tôi.

Page 2 of 2 CHILD SUPPORT GRIEVANCE FORM CSF 01 8643 web (Rev. 11/18/20)

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