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Select An Application Type
Individual
Select if this application is for an individual or a sole proprietorship that does not have an Employer Identification Number (EIN).
Group
Select if this application is for a corporation, a partnership, other business entity, or a sole proprietorship that has an Employer Identification Number (EIN).
   
This Application Is (select one):
Initial Enrollment
Select if you are not currently enrolled in the DC Medicaid program.
Re-enrollment
Select if you are currently enrolled in the DC Medicaid program.
Re-instatement
Select if you were terminated from the DC Medicaid program and are requesting Re-instatement.