To claim zero earnings on your Medicaid application in Oklahoma, download the SoonerCare No Income Self-Attestation Form from the MySoonerCare website, complete the member information and attestation sections, sign it by hand or with a cursor-drawn signature, and upload it back through your MySoonerCare account. The form is one page, covers you and any other household members age 15 or older who also lack income, and takes the Oklahoma Health Care Authority (OHCA) at least 21 business days to process once it arrives.1Oklahoma Health Care Authority. SoonerCare Self-Service
Where to Find the Form
The form is posted on the MySoonerCare page of the OHCA website under the “Documents” heading, available as a PDF in English and Spanish.2Oklahoma Health Care Authority. My SoonerCare You can print it and complete it by hand, or fill it in on a computer. The English PDF is hosted directly on oklahoma.gov in the OHCA forms and instructions directory.3Oklahoma Health Care Authority. No Income Self Attestation Form
If you cannot locate the PDF or have trouble downloading it, call the SoonerCare helpline at 800-987-7767. Staff can walk you through the download or mail a paper copy.4Oklahoma Health Care Authority. Contact Us
Who Has to Complete It
OHCA requires income documentation, or a no-income attestation, for every person in the household who is age 15 or older.3Oklahoma Health Care Authority. No Income Self Attestation Form You attest for yourself in one section. If other people in your household are 15 or older and also have no income, you can attest on their behalf in the second section of the same form. One form covers the whole household.
You will use the form at three points: when you first apply for SoonerCare, at your annual renewal, and any time your income situation changes.
How to Fill Out Each Section
The form is a single page divided into four short parts.
Member Information
At the top, enter your full legal name as it appears on your SoonerCare application, your SoonerCare case number, your individual member ID number, and your Social Security number. The case number and member ID are on any prior OHCA correspondence and inside your MySoonerCare online account. If several people are on the same case, the case number is shared but the member ID is unique to each person.
If you cannot find your case number or member ID, log in to MySoonerCare or call 800-987-7767 before you submit. An incomplete top section is one of the easier ways to lose 21 business days.4Oklahoma Health Care Authority. Contact Us
Your Self-Attestation
The first attestation block is about you. Filling it in certifies that you are not employed and have no other source of income during the past 30 days. That includes wages, self-employment, odd jobs, Social Security, unemployment benefits, rental income, and investment income.3Oklahoma Health Care Authority. No Income Self Attestation Form
If you have any income at all, even sporadic odd jobs or occasional cash from family that counts as income, do not check this box. Report what you have. Some income does not automatically disqualify you from SoonerCare, and honest reporting keeps you out of an overpayment or fraud problem later.
Attestation for Other Household Members
The second block is for other people in your household age 15 or older who also have no income. Write in their names and make the same certification for them. If every adult in the household has zero income, one form handles them all.
Signature and Date
The certification statement at the bottom acknowledges that everything on the form is true and correct and that false statements can result in fraud or perjury penalties, plus repayment to Oklahoma for any claims paid based on false information.3Oklahoma Health Care Authority. No Income Self Attestation Form
One detail catches a lot of people: the signature must be handwritten on paper or drawn with a cursor on screen. Typed signatures are not accepted. If you are completing the PDF on a computer, use your mouse, trackpad, or touchscreen to draw the signature in the signature field. Add your phone number and today’s date. An unsigned or undated form will come back to you for correction.
How to Submit the Completed Form
The fastest route is uploading through your MySoonerCare account. Log in at the OHCA application portal, scan the completed form or take a clear photo, and upload it directly to your case file.5Oklahoma Health Care Authority. Prepare for Application You can then check whether OHCA has received and processed it under submission status in the same account.1Oklahoma Health Care Authority. SoonerCare Self-Service
If you prefer to fax or mail the form, call the SoonerCare helpline at 800-987-7767 first and confirm the current fax number and mailing address for document submissions. OHCA’s contact information has varied across different directories, so verifying with the helpline is worth the phone call.
Two habits worth keeping. First, save a copy of the completed form and whatever confirmation you get: an upload timestamp, a fax receipt, or a certified mail tracking number. Second, pick one submission method and stick with it. Sending the same form through multiple channels creates duplicate entries in your file and slows the review rather than speeding it up.
How Long Processing Takes
OHCA states that all documents take at least 21 business days to process once received, and higher submission volumes can push that further.1Oklahoma Health Care Authority. SoonerCare Self-Service That runs close to a full calendar month. Submit early, especially if a renewal deadline is coming or your initial application is still pending.
After processing, your MySoonerCare account will show an updated status. If OHCA needs anything else, expect a written request through the portal’s messaging system or by regular mail. A final determination letter follows once income verification clears. The attestation stays in your permanent case record and will be referenced at future renewals.
Reporting Income Changes After You Are Enrolled
Once you are on SoonerCare, you have 10 calendar days from the date of any income change to report it.6Oklahoma Health Care Authority. 317:35-5-42 Determination of Countable Income for Individuals Categorically Related to Aged, Blind and Disabled A new job, a Social Security payment, freelance work, unemployment benefits: the 10-day clock starts the day the change happens. Report through MySoonerCare, by calling the helpline, or by submitting updated documentation.
OHCA cross-checks income against federal and state data sources on a continuing basis, including Social Security records, unemployment insurance systems, employer wage reports, bank account data through the Asset Verification System, and public records. If new wages appear in a data exchange while your file still shows zero income, you will get a request for information. Not responding can cost you coverage. Knowingly failing to report income puts you at risk of an overpayment claim or a fraud investigation.
What False Statements Can Cost You
The certification language on the form is not filler. It references Oklahoma Administrative Code sections 317:35-13-6 and 317:35-13-7, which govern fraud and misrepresentation in SoonerCare.3Oklahoma Health Care Authority. No Income Self Attestation Form At a minimum, you can be required to repay the state for every claim paid on your behalf while you were ineligible. That can mean thousands of dollars in medical bills becoming your personal responsibility.
Federal law adds another layer. Under 18 U.S.C. ยง 1347, knowingly defrauding a health care benefit program carries up to 10 years in federal prison, up to 20 years if the fraud results in serious bodily injury, and a possible life sentence if it results in death.7Office of the Law Revision Counsel. 18 USC 1347 – Health Care Fraud The statute exists for large fraud schemes, but it applies to anyone who knowingly submits false information to obtain Medicaid benefits, including a falsely claimed zero income on this form.
If your situation is genuinely no income, sign and submit with confidence. If you have anything at all coming in that you are unsure about, report it and let OHCA decide whether it affects eligibility.