Get Co Aids Drug Assistance Program Recertification Form 2012-2025

This guide provides clear instructions on how to complete the CO Aids Drug Assistance Program Recertification Form online. Renewing your enrollment in this vital program is essential for continued access to medication and health insurance assistance.

Follow the steps to complete your recertification form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin with Section 1, entering your full legal name in the designated fields. If your name has changed in the last 6 months, indicate this by selecting 'Yes' or 'No'.
3. In Section 2, provide your date of birth using the format MM/DD/YYYY.
4. For Section 3, select your ethnicity from the options available.
5. Section 4 requires you to indicate your race. Check all options that apply.
6. Complete Section 5 by selecting your preferred language.
7. In Section 6, indicate your gender by selecting the appropriate option.
8. Section 7 asks about any recent changes in your housing status. Select all that apply.
9. Fill in your current residential address in Section 8. Ensure to attach proof of residency as specified.
10. In Section 9, provide your current mailing address, which can include a PO Box.
11. For Section 10, list your daytime contact phone numbers, indicating if you can receive messages at these numbers.
12. Section 11 includes an optional contact for ADAP if your mail is returned.
13. In Section 12, indicate whether you have a case manager and provide their details if applicable.
14. Section 13 requires you to state your relationship status.
15. Indicate the number of children living with you and those dependent on you in Section 14.
16. Section 15 asks about potential pregnancy if applicable.
17. Next, provide your Social Security Number in Section 16 if you have one.
18. In Section 17, indicate who writes your HIV medication prescriptions.
19. Answer questions regarding your medical history in Sections 19 to 22.
20. Fill in your household income and health insurance details in Sections 23 to 30.
21. Use the income tables in Section 31 to describe your monthly income, attaching proof as directed.
22. Complete the authorization section, ensuring to read all statements before signing.
23. Finally, review your completed form for accuracy, save any changes, and prepare to submit it as instructed.

Get started on your recertification form today to ensure uninterrupted assistance!