Get Npcf Safety Net Program - Application 2020-2025

The NPCF Safety Net Program provides essential financial assistance to children under 18 who are facing advanced cancer treatment-related costs. This guide will walk you through the online application process, ensuring you understand how to complete each section accurately.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the application and open it for editing.
2. Fill in the patient information, including their name, birth date, and the parent or legal guardian's name, ensuring that all details are accurate and matched with their official documents.
3. Confirm the eligibility agreement by indicating 'Yes' or 'No' in the section provided.
4. Complete the home address, phone number, parent/guardian email, and date of application fields to ensure proper communication and correspondence.
5. In the 'Validation / Request for Support' section, check the boxes for your assistance needs (transportation, medical supplies, medication, co-payment/deductible) and provide detailed descriptions of attached documents.
6. Fill out the household financial information accurately, including the number of people and employment status in the household, along with the total annual household income. Attach the last year’s tax return to support this information.
7. Provide the recommending healthcare provider's information, including their name, title, relationship to the patient, diagnosis information, treatment dates, type of treatment, and contact details.
8. Ensure the healthcare provider signs the application to validate the request. They should specify the requested amount alongside attached receipts.
9. The applicant, usually the parent or legal guardian, must verify the accuracy of the application details by signing and dating the form.
10. After completing the application, save your changes, and if applicable, download, print, or share the form as needed before submitting.

Take the first step towards support by completing your NPCF Safety Net Program - Application online today.