AK Form W-10 2020-2025

AK Form W-10: What You Should Know

A copy of the provider's social security card or driver's license. ○ A copy of the provider's voter registration. A copy of the provider's voter registration. ○ A copy of the provider's passport or foreign passport that shows the provider's name and address. A copy of the provider's passport or foreign passport that shows the provider's name and address. ○ A copy of the provider's voter registration card. A copy of the provider's voter registration card. ○ A proof-of-residency form from the department of social and health services. A proof-of-residency form from the department of social and health services. ○ A copy of the social security card or driver's license photo showing the provider's name and address. ○ A copy of the social security card or driver's license photo showing the provider's name, address, and signature. A copy of the social security card or driver's license photo showing the provider's name, address, and signature. ○ A copy of the provider's Social Security Card Number or Driver's License Number, or a copy of the provider's name and address, signed by the caregiver that is the applicant. A copy of the provider's Social Security Card Number or Driver's License Number, or a copy of the provider's name and address, signed by the caregiver that is the applicant. ○ A copy of each government agency and government social welfare card the caregiver is a part of that are issued in the name of the caregiver. A copy of each government agency and government social welfare card the caregiver is a part of that are issued in the name of the caregiver. ○ Copies of any licenses, permits, and tax stamps that show the provider's name, address, and signature. Copies of any licenses, permits, and tax stamps that show the provider's name, address, and signature. ○ The same type of proof as the previous section, except that the identity and date of birth must be checked to verify the identity of the provider. The same type of proof as the previous section, except that the identity and date of birth must be checked to verify the identity of the provider. ○ The identity and date of birth of the caregiver who is the applicant. ○ A copy of the provider's certificate of certification that the applicant is a qualifying patient, as defined in Alaska Statutes § 37.13.

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