Get Lions Hearing Aid Bank Application - Nebraska Commission For The ... - Ncdhh Ne

Filling out the Lions Hearing Aid Bank Application can seem daunting, but it is an essential step to access hearing aid assistance. This guide offers clear instructions on completing the form online, ensuring that you provide all necessary information accurately.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the application form and open it in the online editor.
2. Begin by providing your personal information. Fill in your last name, first name, middle name, and indicate your gender. Then, input your mailing address, including the city, state, zip code, and county. Don't forget to include your email address, last four digits of your Social Security number, date of birth, and telephone number.
3. Next, proceed to fill out the income information section. Enter your gross monthly income and your spouse's gross monthly income if applicable. Specify your source of income by checking the relevant options, such as part-time employment or welfare benefits. If you receive Medicaid, indicate this by selecting 'Yes' or 'No.'
4. In the family information section, indicate your living situation by selecting how you live (alone, with a partner, with a family member, or in a nursing home). List the ages of any dependents if applicable. Additionally, indicate whether you currently wear hearing aids and whether you have applied to Lions before.
5. At the bottom of the application, you will need to certify that the information provided is accurate. Sign your name and date the application. Make sure to return this completed form along with the Citizenship Attestation Form to the address provided for the Nebraska Commission for the Deaf and Hard of Hearing.
6. Once you have completed the application, you may choose to save your changes, download a copy for your records, print the form, or share it as necessary.

Complete your application online today to secure the hearing aid assistance you need.