Embedded Files
Welcome to our Client Forms page, where you can easily access and complete important documents. Below, you'll find the forms you need to get started with our services.
Permission to Contact Form – If you're interested in working with us, please complete this form and return it to us. This allows us to reach out and assist you with your needs.
Medicare Extra Help Application – This application is available online only. You can complete it securely at SSA's official website.
Simply download, print, and fill out the necessary forms. If you have any questions, feel free to reach out—we're here to help!
Important Dates for Clients
**Medicare Annual enrollment periods (October 15th - December 7th)**
Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs
SSA - 1021 Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs.pdfApplication for Enrollment in Medicare Part B (Medical Insurance)
CMS - 40B APPLICATION FOR MEDICARE PART B .pdfGeorgia Application for Medicaid & Medicare Savings for Qualified Beneficiaries
Georgia Application for Medicaid & Medicare Savings for Qualified Beneficiaries.pdfMedicare Income-Related Monthly Adjustment Amount - Life-Changing Event
SSA - 44 (IRMAA Reconsideration).pdfPermission to Contact
Permission to contact form.pdfRequest for Employment Information
CMS - L564 REQUEST FOR EMPLOYMENT INFORMATION.pdfPage updated
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