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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
Call the Eligibility Call Center at 713-566-6509 to check the status of your application.
The Harris Health Financial Assistance Program is not health insurance. It is a financial assistance program used within the Harris Health System. Who is eligible for the Harris Health Financial Assistance program? Residents of Harris County are determined to be eligible based on the income and residency criteria.
The Harris Health Financial Assistance Program is a program that is available to Harris County residents whose gross family income, as it relates to family size, falls at or below at or below 150% of the Federal Poverty Level.
Harris Health Financial Assistance Program (Gold Card) Texas I.D. or drivers license stating the person lives in Harris County. Social Security Card. Citizenship(Passport or Birth Certificate) or Green Card. Proof of income (1 months check stubs) Any bills or bank statement (within 60 days) Income tax (if necessary)
Eligibility. Eligible applicants must: Be 18 or older. Have a household income at or below 200% of the federal poverty line (FPL).