Initiating the Financial Assistance Application Sample Clauses

Initiating the Financial Assistance Application. The Application process can be initiated by the patient or any staff member of the Organization by contacting: Self Pay, Customer Service at (000) 000-0000. This process includes the following: 1. Patients are provided with the Application, a Medi-Cal Application and information on Credit Counseling. 2. Applicants are offered assistance in completing the forms by the following departments: Self Pay, Customer Service, Registration, Admitting, and ED. 3. The Application may be completed orally with assistance from Organization staff but will still require a patient or representative to sign the Application.
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Related to Initiating the Financial Assistance Application

  • Coronavirus Relief Fund – Rental Assistance Application The Coronavirus Relief Fund – Rental Assistance Application should contain all the necessary information to determine whether a Household is potentially eligible for CRF assistance. In accordance with the provisions of Sections 760.20-760.37, Fla. Stat., it is unlawful to discriminate on the basis of race, religion, color, sex, familial status, national origin, or handicap in the award application process for Eligible Housing. 1. At a minimum, an application for program assistance should contain the following items for each household member: a. The number of people residing in the household including name, age, relationship to head of household, current address and home phone number; b. Name and address of employer(s), work phone number(s), and position title with employer; c. Sources of income and a statement signed by all of the adults who reside in the household consenting to the disclosure of information for the purpose of verifying income for determining eligibility for program assistance; d. A signed statement indicating that the applicant understands that all information provided is subject to Florida’s public records laws; and e. A statement that it is a first-degree misdemeanor to falsify information for the purpose of obtaining assistance.

  • OPWC Financial Assistance Subject to the terms and conditions contained herein, the OPWC hereby agrees to provide to the Recipient financial assistance not to exceed the amount as set forth in Appendix C of this Agreement for the sole and express purpose of paying or reimbursing the costs certified to the OPWC under this Agreement for the completion of the Project (the "Funds").

  • PROVISION OF FINANCIAL ASSISTANCE As authorized by Section II of this Agreement for the sole and express purpose of financing the Project defined and described in Appendix A of this Agreement, the estimated costs of which are set forth and described in Appendix D of this Agreement, the OPWC hereby agrees to provide financial assistance, subject to the terms and conditions contained in this Agreement, from the State Capital Improvements Fund which constitutes the proceeds of the Infrastructure Bonds, in an amount not to exceed One Hundred Ninety-Nine Thousand, One Hundred Seventy-Nine Dollars ($199,179). This financial assistance shall be provided in the form of a Grant. The OPWC Grant Control No. is CJ23U.

  • PROVISION OF FINANCIAL ASSISTANCE GRANT As authorized by Section II of this Agreement for the sole and express purpose of financing the Project defined and described in Appendix A of this Agreement, the estimated costs of which are set forth and described in Appendix D of this Agreement, the OPWC hereby agrees to provide financial assistance, subject to the terms and conditions contained in this Agreement, from the State Capital Improvements Fund which constitutes the proceeds of the Infrastructure Bonds, in an amount not to exceed Seven Hundred Forty-One Thousand, Three Hundred Seventy-Four Dollars ($741,374). This financial assistance shall be provided in the form of a Grant. The OPWC Grant Control No. is CK17V.

  • Disbursement of Financial Assistance Unless a different disbursement method is specified in that line of Exhibit C, “Financial Assistance Award,” OHA will disburse the Part A awards for MHS 28 Services provided under a particular line of the Financial Assistance Award containing an “A” in column “Part ABC” to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: i. OHA may, after 30 days (unless parties agree otherwise) written notice to County, reduce the monthly allotments based on under- used allotments identified through MOTS and other reports in accordance with the “Reporting Requirements” and “Special Reporting Requirements” sections above or applicable special conditions; ii. OHA may, upon written request of County, adjust monthly allotments; iii. Upon amendment to the Financial Assistance Award, OHA shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for MHS 28 Services provided under that line of the Financial Assistance Award; iv. OHA is not obligated to provide financial assistance for any MHS 28 Services that are not properly reported in accordance with the “Reporting Requirements” and “Special Reporting Requirements” sections above or as required in an applicable Specialized Service Requirement by the date 60 calendar days after the earlier of expiration or termination of this Agreement; termination of OHA’s obligation to provide financial assistance for MHS 28 Services; or termination of County’s obligation to include the Program Area in which MHS 28 Services fall within its CMHP; and v. OHA will reduce the financial assistance awarded for MHS 28 Services delivered under a particular line of Exhibit C, “Financial Assistance Award,” containing an “A” in column “Part ABC,” by the amount received by a Provider of MHS 28 Services as payment of a portion of the cost of the Services from an Individual receiving such Services with funds awarded in that line of the Financial Assistance Award.

  • Additional Assistance If you do not understand any of the foregoing Terms and Conditions or if you have any questions or comments, we invite you to contact us at any time. This means you should contact us beforehand if anything of these Terms and Conditions is unclear, unfair or unacceptable to you. Our Commitment to Security and Privacy: To prevent unauthorized access, maintain data accuracy, and ensure the correct use of information, we have put in place the appropriate and reasonable physical, electronic, and managerial procedures to safeguard and secure the information we collect online. Please see our Privacy Policy for further information.

  • Financial Assistance Subject to the terms and conditions contained herein, the Director hereby grants to the Recipient financial assistance, as established in this section, for the sole and express purpose of paying or reimbursing the eligible costs certified to the Director under this Agreement for the completion of the Project.

  • Certification Regarding Prohibition of Boycotting Israel (Tex Gov. Code 2271)

  • Mutual Assistance The Parties will do all things reasonably necessary or appropriate to carry out the terms and provisions of this Agreement and to aid and assist each other in carrying out such terms and provisions.

  • Grant of Financial Assistance Subject to the terms and conditions contained herein, the OPWC hereby grants to the Recipient financial assistance not to exceed the amount, as set forth in Appendix C of this Agreement for the sole and express purpose of paying or reimbursing the costs certified to the OPWC under this Agreement for the completion of the Project.

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