Get Fdny Surgical Assistance Fund

The Fdny Surgical Assistance Fund offers support for eligible individuals seeking financial assistance for surgical procedures. This guide provides a clear, step-by-step approach to help users efficiently fill out the benefit application form online.

Follow the steps to complete your application for the Fdny Surgical Assistance Fund.

1. Press the ‘Get Form’ button to access the application form and open it in your online editor.
2. Fill in the date at the top of the form where indicated.
3. Select your status by checking one of the three boxes: Active, Retired, or Widow.
4. In the Rank field, enter your rank, and indicate the unit related to dues paid.
5. If retired, provide the date of retirement and the unit you were part of.
6. Enter your full name in the designated space.
7. Provide the last four digits of your Social Security Number.
8. Fill in your address, ensuring all components — street, town, state, and zip code — are included.
9. Input your telephone number for contact purposes.
10. In the patient information section, enter the name and age of the patient.
11. Specify your relationship to the member, and if the patient is a child, provide their date of birth.
12. Indicate the date of the operation and whether the procedure was covered by FDNY Compensation.
13. Describe the type of procedure performed.
14. Attach one of the required documents: a signed statement from a doctor, a GHI or Medicare benefit form, or an operating report from the hospital.
15. Ensure that the submission includes the name of the patient, the date of the procedure, and the nature of the procedure.
16. Include a stamped, self-addressed postcard or envelope if you wish to receive an acknowledgment of your claim.
17. Acknowledge that anesthesia costs are not covered by the fund and that claims older than one year will not be considered.
18. Sign the application in the designated space provided.
19. After completing the form, save your changes, and choose to download, print, or share the document as needed.

Complete your application for the Fdny Surgical Assistance Fund online today.