TN 5 (03-12)
SI 00604.114 Claimant's Residence Address: Question 3
A. When and how to complete question 3
Complete when the claimant's residence address differs from his or her mailing address or when there is a representative payee. Enter the state and county. We need this information to determine the correct amount of state payments and to establish categorical Medicaid eligibility. When the state of residence is not clear, see SI 01410.001 Eligibility for State Supplementary Payments, through SI 01410.050 Public Contact About State and County of Residence.
NOTE: If the claimant owns a home in another state and we are excluding that home as the principal place of residence because of intent to return, use the state where that home is located.
B. Requirement for mailing address
Use a mailing address to which the U.S. Post Office can deliver mail per SM 01005.400.