Thanks for being a volunteer!
We appreciate your help in this effort. Thank you for being accurate when entering all information.
Your help ensures that all children in SC will receive the health care they deserve.
On this page, you will find all the forms that you will need.
Please print and add to your training manual. This chart has been updated to include not only the three major categories of Medicaid that affect children and families in SC, but also income limits for the Health Insurance Marketplace.
Pending — Annual Review Form (Medicaid Renewal Application)
3308 Form Citizenship & Identity Copy Page
1282 Form Authorization for Release of Information/Authorized Representative
OCCASIONAL USE FORMS
3298 Form Statement of Child’s Identity
2700 Form Medical Support Referral
1216 Form Voluntary Child Support Contribution
1245 Form Wage Statement
The palm card can be printed double-sided on 8-1/2 x 11 paper and then cut into four cards.
The poster is sized to be printed on 8-1/2 x 11 paper so it is usable in a variety of locations.