Get Colorado Aids Drug Assistance Program Recertification Form - Colorado

Completing the Colorado AIDS Drug Assistance Program Recertification Form online is an essential step to ensure continued access to necessary medication and support services. This guide will provide you with straightforward instructions on how to accurately fill out each section of the form.

Follow the steps to successfully complete the recertification form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing your full legal name, including last name, first name, and middle initial. Indicate if this has changed since your last recertification.
3. Enter your date of birth in the format MM/DD/YYYY. This information is crucial for your identification.
4. Indicate if your gender status has changed since your last recertification by selecting 'Yes' or 'No.' If applicable, provide a brief description of the changes.
5. Detail your current housing status by selecting the appropriate option, such as permanent housing, institution, temporary housing, or homelessness.
6. Provide your current residential address, ensuring that P.O. Boxes are not used. Check if we may contact you at this address.
7. List your current mailing address, noting that P.O. Boxes are accepted. Confirm if we may contact you at this mailing address as well.
8. Fill in your daytime phone numbers where we can reach you, checking the appropriate designation (home, work, cell). Indicate whether messages can be left on these numbers.
9. Specify if there is an alternative contact person we can reach if your mail is returned or if your phone number does not work.
10. Complete the additional questions regarding your ethnicity, ancestry, and interest in receiving text message reminders.
11. Provide details about your current case manager or social worker, if applicable. If you do not have one, indicate if you would like a referral.
12. Answer questions regarding your relationship status and household size. Be mindful that household income affects your eligibility.
13. Declare your employment status and provide details about your income, including gross monthly earnings from all sources.
14. Certify the accuracy of your application by signing the certification and authorization of the release of information section. Ensure that you understand the consequences of providing false information.
15. Submit the completed form by saving any changes, downloading for your records, and sharing as necessary before sending it to the specified address.

Complete your recertification form online today to maintain your access to necessary assistance and services.