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Beneficiaries must respond by a stated deadline, complete all questions, and sign the application after reviewing Rights and Responsibilities. The packet requires supporting documents to verify eligibility, including income, bank statements, and additional items such as living expense changes, trust statements, life insurance cash surrender value, and health insurance premium changes. 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You must respond by or lose your benefits.  \n1. Complete the application, answer all questions and sign the last page of the application after reading the Rights and Responsibilities section. Be sure to tell us about any changes since your last eligibility determination for you and your spouse.  \n2. Provide copies of the following documents to verify eligibility.  \nAll beneficiaries:  \n • Income   \n• Most recent statement for all bank accounts (including accounts closed since your last determination)  \nIf applicable:  \n• Changes in living expenses  \n• Personal Needs Allowance (PNA) account  \n• All Qualified Income Trust/Special Needs Trust bank statements since your last determination  \n• Current cash surrender value of life insurance policy  \n• Plan of liquidation documents (for example: listing agreement, closing settlement)  \n• Changes in Medicare or other health insurance premiums  \n3. Mail the application and all supporting documents in the envelope provided.  \nYou will receive a letter when your Renewal Application is processed. If you have any questions or need help, call at extension .  \nSincerely,  \nNJ FamilyCare  \nAged, Blind, Disabled Programs  \nSTATE OF NEW JERSEY  \nDepartment of Human Services Division of Medical Assistance and Health Services  \nRENEWAL APPLICATION  \nINSTRUCTIONS:  \nThis form must be completed to continue benefits. The Beneficiary is the person already enrolled in the NJ FamilyCare Aged, Blind, Disabled programs.  \nSECTION 1 Demographic Information  \nBeneficiary’s Name:  \nPLEASE PRINT  \nLast First Middle  \nHome Address:  \nStreet City State Zip Code  \nCurrent Mailing Address (if different from above):  \nStreet City State Zip Code  \nIs Beneficiary living in a facility? q Yes q No  \nBeneficiary’s Phone Number: (   )   -  Medicare ID Number:    \nMarital Status: q Single q Married, Date   q Divorced, Date    \nq Widowed, Spouse’s Date of Death   . q Separated, Date    \nq Child (under age 19)  \nSpouse’s Address (last known):   \nStreet City State Zip Code  \nCitizenship Status:  \nq US citizen or US national q Naturalized or derived citizen (born outside of the US) If naturalized or derived citizen, enter  \nUSCIS \\#  and Certificate \\#   \nCertificate Type: q Naturalization Certificate q Certificate of Citizenship If not a citizen, does the Beneficiary have an eligible immigration status?  \nExamples of eligible immigration status are:  \n• Child under age 21 or pregnant woman: Lawfully residing in the US  \n• Adult: Lawful Permanent Resident for 5 years OR qualified non-citizen, such as refugee or asylee  \nFOR OFFICE USE ONLY  \nDate Received   Case \\#    \nNJ FC-ABD-RA-1222  \nRenewal Application for Aged, Blind and Disabled Programs  \nSECTION 1-DEMOGRAPHIC INFORMATION-continued  \nq Yes, enter information below: q No  \nImmigration document type  Status type (optional)  Beneficiary’s name as it appears on immigration document  USCIS or I-94 number  Card or Passport Number  SEVIS ID or expiration date (optional)    \nOther (category code or country of origin)  Has the Beneficiary lived in the US since 1996? q Yes q No  \nIs the Beneficiary, or Beneficiary’s spouse or parent, a veteran or an active-duty member of the US military? q Yes q No  \nSocial Security Number (SSN):   –   –   \nYour answers to questions about race and ethnicity can help us serve the community better. They will not affect if you qualify for coverage or what services you can receive.  \nRace (Check all that apply) q Prefer not to answer  \nq White q Asian Indian q Korean q Guamanian or Chamorro  \nq American Indian q Chinese q Vietnamese q Native Hawaiian  \nor Alaska Native q Filipino q Other Asian: q Samoan  \nq Black or African American q Japanese   q Other Pacific Islander:  \nq Other:    Ethnicity (Check all that apply) q Prefer not to answer  \nq Mexican, Mexican American, q Puerto Rican q Another Hispanic, Latino/a, or Spanish","cbCaimHa5P3ZbyiT","https://ap.wps.com/l/cbCaimHa5P3ZbyiT","pdf",178739,9,"English","# Renewal Application for Aged, Blind and Disabled Programs\n## Renewal instructions\n## Section 1 Demographic Information\n## Section 2 Changes since the last eligibility determination\n## Section 3 Beneficiary’s Income","[{\"question\":\"What is required to renew NJ FamilyCare Aged, Blind, Disabled benefits?\",\"answer\":\"Complete the application, answer all questions, and sign the last page after reading the Rights and Responsibilities section. Respond by the deadline listed in the notice to avoid losing benefits.\"},{\"question\":\"Which documents must be provided to verify eligibility?\",\"answer\":\"Provide copies of income information and the most recent statement for all bank accounts (including accounts closed since the last determination). Additional documents may be required for changes in living expenses, PNA accounts, qualified income trusts/special needs trusts, life insurance cash surrender value, and liquidation plan documents, as applicable.\"},{\"question\":\"What does the application collect in Section 1?\",\"answer\":\"Section 1 collects beneficiary demographic details including name, home and mailing addresses, facility living status, phone number, Medicare ID, marital status, spouse information, citizenship/immigration status and document numbers, and race/ethnicity information.\"}]","ABD renewal letter and application - Renewal Application for Aged, Blind and Disabled Programs | PDF",1789833018]