Autofill Ontario Determination Available Monthly Income
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 hivi.
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 hivi makes it faster
- Save it once. Store your resident name, health number, and address in your hivi profile.
- Keep documents ready. Upload supporting documents to hivi Files so you are not searching at form time.
- Autofill the form. Use the hivi Chrome extension on a web form, or fill a PDF from your saved profile inside hivi.
- Review and submit yourself through the official channel.
Why do it in hivi
Related Ontario forms repeat the same personal details. Captured once in hivi — stored in Canada, with AI on its own servers — every form starts mostly complete.