Get (hrsa) Application - Excel Pediatrics & Family Care

This guide provides a detailed overview of the HRSA application required for Excel Pediatrics & Family Care. By following these instructions, you will be able to fill out the application accurately and efficiently to ensure eligibility for discounted services.

Follow the steps to complete the HRSA application online.

1. Click ‘Get Form’ button to access the HRSA application form and open it in your preferred editor.
2. Begin by entering the name of the head of household in the designated field. Be sure to gather any necessary identification documents to support your application.
3. Provide the street address, city, state, and ZIP code in the respective fields. Accurate information is critical for the processing of your application.
4. In the employment section, list the place of employment of the head of household. If not applicable, you can indicate 'not applicable'.
5. Fill out the health insurance plan information, if applicable. Include any relevant details about your current coverage.
6. Input the social security number of the head of household and ensure that it is entered correctly to avoid delays.
7. List all dependents under age 18 under the provided spaces. Include full names and dates of birth as needed.
8. Report the annual household income by providing accurate figures for gross wages, pensions, and any other forms of income in the highlighted sections.
9. Certify the correctness of the information by signing and printing your name and including the date. This section assures that the data provided is truthful.
10. Review your completed application for accuracy. Once satisfied, save your changes, download a copy for your records, and print it if necessary.

Complete your HRSA application online today to apply for essential services.