Form Mc 360 PDF Details

As you may be aware, the IRS has introduced a new tax form this year - Form Mc 360. Designed to make it easier for taxpayers to report their foreign financial assets, Form Mc 360 replaces Forms 8938 and 3520. If you have foreign assets that you need to report on your taxes, be sure to use Form Mc 360 instead of the old forms. Depending on your particular situation, there may be benefits to using Form Mc 360 instead of Forms 8938 or 3520. For more information, be sure to consult a qualified tax professional.

Form NameForm Mc 360
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesinter county transfer form, INTERCOUNTY, intercounty transfer form, inter county transfer medi cal form

Form Preview Example

State of California—Health and Human Services Agency

Department of Health Care Services


Instructions: Complete each space or box. If information does not pertain to this case, indicate with N/A.

Receiving county name and address

Sending county name and address



Case Name/Beneficiary Information

Case name



Phone number

Alternate phone number








Address (number, street)



ZIP code






Authorized representative (AR)

AR name

AR phone number

Beneficiary’s primary language















Receiving county follow­up on changes related to intercounty transfer

Medi­Cal Family Budget Unit (If person is excluded, please indicate.)


Aid Code

Income/How Often Received

Share­of­Cost (SOC)



Other Case Information

CE for: _________________________________________

CEC for: ________________________________________

CEC period: _____________________________________

TMC period: _____________________________________

Annual redetermination due date: ___________________

LTC period of ineligibility: __________________________

Court case: _____________________________________

Other: _________________________________________

Documents in Transfer Packet


Statement of Facts and applicable supplements/MC 210 RV

Pregnancy verification for: _________________________


Social security card(s)



Primary wage earner: _____________________________





MC 13s and Proof of Alien Status for: ________________







Case narrative










Budget work sheets for MFBU/MBU


Property verifications or MC 176 P



Family Support Information (CW 2.1s)


Computer generated case documents


Authorized Representative Form/Letter


Last NOAs for share­of­cost






SP­DDSD Decision/Incapacity Verification for: _________


Income verifications








Other Health Coverage Information (DHCS 6155)


Other(s) (list): ___________________________________










Sending County Worker Information




Worker name



Worker number

Date ICT packet sent






Phone number

Fax number


E­mail address














MC 360 (06/07)

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The right way to fill out NOAs portion 1

2. When this selection of blank fields is completed, proceed to enter the suitable details in these: Name, Aid Code, IncomeHow Often Received, ShareofCost SOC, Other Case Information, CE for CEC for CEC period TMC, Annual redetermination due date, Documents in Transfer Packet, Statement of Facts and applicable, Social security cards, Identifications, Case narrative, Budget work sheets for MFBUMBU, Computer generated case documents, and Last NOAs for shareofcost.

NOAs writing process explained (part 2)

3. Completing Other Health Coverage Information, Sending County Worker Information, Pregnancy verification for, Worker number, Date ICT packet sent, Phone number, Fax number, and Email address is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

NOAs writing process explained (part 3)

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