Get Credit/financial Assistance Application - Altru Health System - Altru

Filling out the Credit/Financial Assistance Application is an essential step for individuals seeking financial support from Altru Health System. This guide will provide clear, step-by-step instructions on how to complete the application accurately and effectively, enabling the organization to assess your financial situation.

Follow the steps to complete the application correctly.

1. Click the ‘Get Form’ button to access the Credit/Financial Assistance Application. This will allow you to obtain the form and open it for filling out.
2. Begin by entering the date and your account number(s) at the top of the form. Make sure these are accurate as they will be crucial for processing your application.
3. Provide personal information, including your responsible party's name, Social Security number, and date of birth. This information will help identify you and your case.
4. Fill out your address details thoroughly, including street or P.O. Box, apartment number (if applicable), city, state, zip code, and how many years you have lived at your current address.
5. Input your contact numbers including home, work, and cell numbers. This information will enable Altru Health System to reach you if required.
6. Document your employment details, including the name of your employer, job title, and the employment address. Include how many years you have been employed in your current position.
7. List details of any dependents other than your partner, along with their ages, to provide a clear depiction of your household circumstances.
8. Include similar employment details for your spouse or significant other if applicable.
9. Answer optional questions regarding your ethnicity/race and any roommates, outlining if they share expenses with you.
10. Respond to inquiries about any medical assistance or accident-related claims you may have, including statuses of applications for services such as Medicaid or Medicare.
11. Proceed to the income section by detailing your monthly net income from all sources, alongside declaring any relevant assets such as life insurance, stocks, pensions, etc.
12. Provide a clear breakdown of your monthly expenses using the designated columns for rent, utilities, bills, loans, and other financial obligations.
13. Take special care with the outstanding medical bills section; input accurate current balances and payment terms for each medical facility involved.
14. Review the declaration statement for accuracy, ensuring all provided information is truthful to your best knowledge.
15. Finally, sign and date the application at the designated areas to confirm your cooperation and authorize verification of your credit and employment history. Save your changes, download a copy of the form for your records, and print it if necessary.

Complete your Credit/Financial Assistance Application online today to take the first step towards receiving the support you need.