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Note: In order for the course to properly track your progress, links to external webpages will load in new browser windows or tabs. Identify how to use online tools to determine the applicant’s correct mailing address and round-trip mileage. Providers should submit complete applications on behalf of their patients because incomplete applications significantly delay application processing. A complete KHC application requires an application form with all fields filled in, and the four pieces of documentation in the list below.
Additionally, KHC requests that you verify the applicant’s mailing address through the USPS website and the round-trip mileage using Google maps before submitting the application. The application with all the supporting documents attached, must be signed by the applicant and notarized. This document is a requirement for KHC eligibility because it is the only source for verification of the physician’s diagnosis of the primary disease causing renal failure. Date Self-dialysis Training began, Provider & Medicare Number, Type of Training, Will Patient Self Dialyze and date patient is expected to complete the training. View an example of a CMS 2728 that shows you where to find the information that KHC requires. Social Security numbers are required because KHC uses them to coordinate client benefits and to communicate with Texas Medicaid. A copy of the front and back of the applicant’s Social Security card issued by the Social Security Administration.
A copy of any official Social Security Administration document that verifies the Social Security number. In cases where the applicant can only provide a residency document that shows someone else’s name, KHC will accept the document.
Below is a list of the documents that can be used to establish Texas residency on the KHC application. Valid Texas Driver’s license or current Texas ID card issued by the Texas Department of Public Safety. Utility bill or payment receipt with date, name and address imprinted (not handwritten from one of the three months immediately preceding the date of the KHC application. Payroll or retirement check with the date, name and address imprinted (not handwritten) and dated within three months immediately preceding the date of the KHC application.
Texas motor vehicle registration with expiration date within the next 12 months, or automobile license plate registration renewal form dated within three months immediately preceding the date of the KHC application. Mortgage payment receipt issued or received from one of the three months preceding the date of the KHC application. Rent payment receipt issued or received to show the date, name and address imprinted (not handwritten) from one of the three months preceding the date of the KHC application. Employment or unemployment records with the name, date, and address imprinted (not handwritten) on the document and prepared within three months immediately preceding the date of the KHC application.
Statement from a financial institution (bank, credit union, etc.) with date, name and address imprinted (not handwritten) on the document and issued within three months immediately preceding the date of the KHC application. Social Security supplemental income or disability records or Social Security retirement benefit records with the name, date, and current address imprinted (not handwritten) on the document and issued within three months immediately preceding the date of KHC application. This document is used to verify that the applicant has an annual gross income of less than $60,000.
If the document does not show income for the entire year, you are responsible for calculating the annual amount based on the information contained in the verification document. KHC needs a mailing address that can be verified through the United States Postal Service (USPS) online lookup system in order to approve the application. The RTM is used to determine the allowable travel reimbursement from a client’s physical address to a dialysis facility and back.

Ask post-transplant applicants or applicants on home dialysis how far they drive to the location where they receive kidney-related follow-up care. For in-center dialysis applicants find the distance from their home to the dialysis facility. For post-transplant applicants or applicants on home dialysis find out the distance from their home to the location where they receive kidney-related follow-up care.
If the applicant believes that the RTM Google Maps calculates is too low, make a note on the application and KHC staff will re-calculate the RTM to determine if the applicant is entitled to additional mileage. KHC will review complete applications in order to determine eligibility for each of the benefits KHC offers. KHC verifies every applicant’s Medicaid status by looking him or her up in the Medicaid database.
Some clients will receive all the benefits KHC offers, while others may only get one or two for a short time.
Once KHC determines the applicant’s eligibility for benefits, it mails a denial letter or a Notice of Eligibility (NOE) to the applicant and one to the social worker or representative at the facility indicated on the application. The KHC eligibility effective date for approved applications will be the date KHC received the complete application with all required documentation. In 1866, the Legislative Assembly of the Washington Territory passed the Act to Regulate Marriages, citing the need for marriage license recordkeeping.
Marriage licenses themselves were customarily retained by the ceremony officiator and therefore will not generally be held by county agencies. Originally, there was no limitation on how long a couple could wait to marry after receiving a marriage license.
Since much of family history research is done by stepping back through time, death records are often the first found for our ancestors. Even though you may be able to find death records online, you should also make every effort to obtain a copy of the original death record as it was filed at the time of death in the city or town where the death occurred. If you manage this site and have a question about why the site is not available, please contact us directly. Providers will only have two weeks after submission of an incomplete application to make those applications complete. The provider must submit the complete application to KHC via US mail or electronically through ASKITWeb.
In most cases, because it shows the date of first dialysis, it establishes KHC’s date of record for the first ESRD service. KHC does not accept photocopies of metal Social Security cards because they are not issued by the Social Security Administration. The number and identification information must be printed on the document, not handwritten. However, if the copy of the document you use for the application package shows a Texas address that is different than the one written on the application itself, you must include an explanation for why the addresses do not match. However, you must include additional supporting documentation in the application to prove the relationship between the applicant and the person whose name is on the residency document.
For example, a receipt or bill from an electric, telephone (land line, not wireless), cable, water, or sanitation company is acceptable. The payment booklet stub that is sent with the payment is not acceptable, unless submitted with additional documentation to show that it has been paid. The document can be typed or handwritten by the applicant, social worker or individual providing the rent free housing.
Reported income pertains to the financially responsible person and is considered joint income for legally married applicants.
For example, you must multiply the monthly direct deposit shown on a bank statement by twelve to provide an estimate for the year in order to fulfill the annual income requirement on the KHC Application for Benefits.

Therefore, KHC recommends that you verify the mailing address on that system first and correct any errors before submitting an application in order to avoid a delay in the application’s processing.
If the client is post-transplant or on home dialysis, the RTM is from the client’s home to the transplant hospital or other place where the client receives kidney-related follow-up care and back. If the mileage KHC calculates for the address-to-address distance is the same or less than what is on the application, KHC will use its calculation to determine reimbursement. It is very important that providers keep their clients’ records updated with KHC because their benefits can change depending on the type of treatment they receive or what kind of coverage they have from other sources.
By law, the County Auditor retained a ledger record of pertinent information from the license (license issue date and number) (Marriage License Register).
The King County Archives does retain a very small number of early marriage licenses in its collections (Marriage Licenses).
As a result, there are isolated cases of couples waiting as long as 17 years to marry after license issuance. It is not known why the licenses were in the county’s custody, since by law they should have been retained by the officiator. The volumes from 1866-1889 have self-contained indexes and the volumes from 1889-1917 can be accessed using the Indexes to Marriage Licenses (below). Volumes between 1880 and 1894 have been digitized and are available online on the Washington State Digital Archives (external link).
Entries from 1889 to 1917 additionally include the volume and page number of the Marriage License Register. Depending upon the completeness of the death record, it can reveal the date and location of death, age at death (which can be used to calculate an approximate date of birth if none is specifically listed), cause of death, as well as the names of parents. Where possible, a copy should be just that - a photostat copy or scanned digital image of the original death certificate or death record as it was originally recorded shortly after the death of the individual in question. Providers are ultimately responsible for making sure their applications are complete, but KHC will be available to assist providers in any way if they have trouble completing an application.
If the mileage KHC calculates for the address-to-address distance is more than what is on the application, KHC will use the mileage shown on the application. The licenses were issued by the County Auditor from 1866 until 1969 and by the Recorder’s Office since 1969. After 1917, the license recordkeeping consisted of recording the license numbers and issue dates in volumes indexed semi-alphabetically (Indexes to Marriage License). Entries from 1917 to 1978 include the license number instead of the volume and page number. When using death records, keep in mind that the information about the deceased is provided by someone else, so it is not uncommon to find incorrect information in the official death certificate.
Transcribed records always introduce the chance for additional errors or ommissions which may complicate your research further down the line. Providers also need to be aware that incomplete applications will be denied after two weeks. You will learn the specifics about each type of benefit in the lessons that follow this one. Entries after 1946 also include the date of the marriage and also serve as a certificate index.

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