What Form 4 for long-term care income asks for — and how to autofill 014-4500-69 with my-id.ca
Report monthly income for LTC co-payment without retyping resident details
Long-term care residents completing Form 4 for co-payment assessment repeat their name, health number, address, and income sources on every determination filing. This guide is an example of storing them once in my-id.ca.
Official form and source
Start from the official source and always use the current version — form numbers and links can change:
- Service page: Paying for long-term care — ontario.ca
- Form (Central Forms Repository): Determination of Available Monthly Income Form 4 — 014-4500-69
What this form is about
Form 014-4500-69 is Determination of Available Monthly Income (Form 4), used in the long-term care co-payment process to declare income and calculate the resident's share of accommodation costs.
Before you start: what to gather
- Resident full legal name and Ontario health number.
- Resident address and long-term care home name.
- Monthly income sources (pension, investments, employment, other).
- Spouse or dependent income if applicable to the assessment.
Confirm the current process on ontario.ca.
How my-id.ca makes it faster
- Save it once. Store your resident name, health number, and address in your my-id.ca profile.
- Keep documents ready. Upload supporting documents to my-id.ca Files so you are not searching at form time.
- Autofill the form. Use the my-id.ca Chrome extension on a web form, or fill a PDF from your saved profile inside my-id.ca.
- Review and submit yourself through the official channel.
Why do it in my-id.ca
Related Ontario forms repeat the same personal details. Captured once in my-id.ca — stored in Canada, with AI on its own servers — every form starts mostly complete.
Frequently asked questions
- Who completes Form 4?
- Residents or their authorized representatives as part of co-payment assessment — confirm with your long-term care home.
- How does my-id.ca help?
- It autofills resident names, health numbers, and addresses.
- Is this the same as a co-payment reduction application?
- Form 4 is part of the income determination process; reduction applications use separate forms — confirm on ontario.ca.
Fill it once. Reuse it everywhere.
Save your information in my-id.ca once, then autofill this form and the next one — web forms with the Chrome extension, PDFs right in the app. Your data is stored in Canada and AI runs on my-id.ca's own servers, never sent to third-party AI providers.