Form 3048, Notice of Eligibility

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Effective Date

7/2025
3048.pdf , 3048-s.pdf , f3048-s-instructions.pdf

Instructions

Updated: 7/2025

Purpose

Form 3048 notifies applicants they are eligible for Epilepsy Program benefits.

Form 3048 also notifies Epilepsy Program benefit clients to report changes in their situation and their liability if they fail to report changes.

When to Prepare

Complete the form for people who apply for the Epilepsy Program benefits.

Number of Copies

Complete an original and one copy.

Transmittal

Give the original form face-to-face or mail the form to the person who applies for assistance. File a copy in the case record.

Form Retention

Keep the case record copy for three state fiscal years after eligibility begins. Eligibility, however, is valid for a maximum of 12 months.

Detailed Instructions

Complete the information listed on the form.