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Printable Form 2106 Nassau New York: What You Should Know

Request for Qualifying Information If you are not an existing NY/NJ resident or if you have never filed a NY/NJ tax return, your tax return must request your county of residence address in order to apply for non-qualified medical Apply here for a NY state medical program. For a detailed instruction on how to apply, scroll to the bottom Instructions for Form IT-215 Resident Income Tax Return (Self-Eligible Individual) You will need your mailing address, Social Security Number (SSN), IRS employer identification number, taxpayer identification number (TIN) and the New York SSA/IS/NSW for this filing request. You will also be asked for your social security, income, and filing status (married, single, head of household). If eligible, you will need the TIN of the recipient who received your W-2G. After your filing form is received, you will have up to 28 days to fill out and send in your paperwork. Instructions for Form IT-216 Resident Income Tax Return (Self-Eligible Individual) You will need your mailing address, Social Security Number (SSN), IRS employer identification number, taxpayer identification number (TIN) and the New York SSA/IS/NSW for this filing request. You will also be asked for your social security, income, and filing status (married, single, head of household). If eligible, you will need the applicant's own SSN. If you are seeking a non-qualified NY Medicaid plan through NY Health Connect website, you will have to fill out the form from here. You can call the NYS Department of Taxation at to ask for this form. For more information, go to: Department of Taxation About Form IT-217 Resident Income Tax Return (Self-Eligible Individual) You will need your mailing address, Social Security Number (SSN), IRS employer identification number, taxpayer identification number (TIN) and the New York SSA/IS/NSW for this filing request. You will also be asked for your social security, income, and filing status (married, single, head of household). To qualify for the non-qualified NY Medicaid plan, you will need someone else to provide the information you do. Otherwise, you may not be eligible.

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