10/6/2017 10:03:21 AM
The 11-17 version of the Application for Health Coverage and Help Paying Costs (DHS-6996) will be available on eDocs on November 1, 2017, in English and five other languages. The version dated 11-17 was updated to clarify information for applicants. See /assets/20171006-11-17-OE-Application-Updates_tcm34-313989.pdf2018 Application Health Coverage Help Paying Costs Updates for a list of changes from the old form.
Printed copies of the English-language 11-17 application are available for order on the DHS bulk order website. However, please do not provide the 11-16 version to applicants until it is available on eDocs on November 1.
When the updated version of the application is posted to eDocs, please stop distributing copies of the 11-16 version and destroy those copies.
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