With our office being closed to clients, we’d like to make it easier for you to access the necessary forms you may need when we process your applications for health coverage. You will find them in the links below.
** Sending personal info via email does not ensure it’s security. Please drop off or fax whenever possible to 413-664-5094.
Navigator Designation Form https://www.mahealthconnector.org/wp-content/uploads/navigator-designation-form.pdf
Residency https://www.mass.gov/doc/affidavit-to-verify-massachusetts-residency-english-0/download
Income https://www.mass.gov/doc/affidavit-to-verify-zero-income-english-0/download
Job update form https://www.mass.gov/doc/masshealth-job-update-form/download
Non-Custodial Parent Form https://www.mass.gov/doc/noncustodial-parent-form-english-0/download
Incarceration status https://www.mass.gov/doc/affidavit-to-verify-incarceration-status-english-0/download
Self Attestation Form – Income Verify: https://www.mass.gov/doc/attestation-form-to-verify-income/download
Self Attestation Form – Self-Employment: https://www.mass.gov/doc/verification-of-self-employment-income/download