Get Financial Assistance Application - Augusta Health

This guide provides a comprehensive overview of how to fill out the Financial Assistance Application for Augusta Health online. It is designed to assist users in navigating the application process smoothly while ensuring that all necessary information is accurately provided.

Follow the steps to complete your application for financial assistance.

1. Press the ‘Get Form’ button to acquire the Financial Assistance Application and open it for editing.
2. Begin by entering your household members, including yourself, your partner, and any dependent children under the age of 21 living in your home. Fill in the family size as required.
3. Provide the applicant's full legal name, social security number, and date of birth. Ensure this information is accurate to avoid processing delays.
4. If applicable, provide the legal name of your partner along with their social security number and date of birth.
5. Complete the mailing address section, including the street, city, state, zip code, and phone number.
6. List any dependent children under the age of 21. Fill in their legal names, ages, social security numbers, relationships to the applicant, and dates of birth.
7. Input your total income for the last three months, including both earned and unearned income using the 'before deductions' amount. Make sure to attach proof of this income as specified.
8. Read the certification section carefully and verify that all the information provided is accurate. Sign and date the application form as required.
9. After completing the application, save your changes and consider downloading or printing the application for your records before submitting it.
10. Lastly, mail the completed application to the Augusta Health Business Office at the provided mailing address.

Complete your Financial Assistance Application online today to ensure you receive the support you need.