Find an Assistance Program
Privacy: The information you provide here will be used to identify program(s) that may be right for you.
Your answers will not be stored or used for any other purpose.
Step 1 of 3: Tell us about yourself
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Step 1 of 3 |
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To find the right program(s) for you, we just need a little information. |
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1. |
Are you unemployed?
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2. |
If yes, did you become unemployed on or after January 1, 2009?
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3. |
Do you currently have
insurance coverage
Insurance coverage
Insurance coverage includes Medicaid/Medicare prescription drug coverage; state-sponsored
prescription drug assistance programs; employee, military, retirement, or pension
program drug coverage.
for your prescription medicines?
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4. |
Are you eligible for Medicare?
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5. |
What is your marital status?
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6. |
What is your total yearly household income
Household income
Household income includes all money that comes into your household. If you are married
and live with your spouse, you must include both of your incomes. You must also
include income earned by dependents living with you.
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ex: |
20,000
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7. |
How many people are in your household?
(Include yourself, your spouse, and any dependents you claim on your tax return.)
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8. |
In what state do you live?
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9. |
What is your date of birth?
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ex: |
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10. |
How did you learn about this Web site? (optional) |
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