Get Ga Tift Regional Health System Financial Assistance Application 2023-2025

The GA Tift Regional Health System Financial Assistance Application is designed to help eligible individuals obtain financial support for their medical bills. This guide provides detailed instructions on how to fill out the application online, ensuring you submit all required information accurately.

Follow the steps to complete the application online effectively.

1. Use the 'Get Form' button to access the application form and open it in your preferred digital editor.
2. Begin by entering your personal information in the fields provided. This includes your last name, first name, middle name, marital status, mailing address, city, state, zip code, and county. Make sure all details are accurate.
3. In the household members section, list all individuals residing in your household, including yourself and any dependents under the age of 21. Clearly indicate each person's name, relationship to you, date of birth, and insurance information if applicable.
4. Next, document all household members with income. Include each person's name, relationship, type of income, gross income amount per pay period, and the frequency of payment (weekly, bi-weekly, or monthly).
5. Record all household assets in the designated section. List the primary owner’s name, asset type, location, and asset value for properties, vehicles, bank accounts, and any investments.
6. Ensure you complete the Marital Attestation form if applicable, selecting the appropriate status and providing necessary documentation as stated in the application.
7. Once all sections are filled out, review the form for accuracy and completeness. Verify that you have signed and dated the application, and that all required documentation is attached.
8. Finally, you may save your changes, download, print, or share the filled application as needed before submission. Make sure to return the completed application and all required documents to the Financial Counseling Unit at Tift Regional Health System, Inc.

Apply for financial assistance by completing the GA Tift Regional Health System Financial Assistance Application online today.