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COMMUNITY EVENT AGREEMENT FORM Thank you for your support of Participation House Support Services London and Area (PASS) through your involvement and planning of a community event. Please complete,
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How to fill out PHSS:

Gather all necessary information:

01
Make sure you have all relevant personal details, such as full name, address, contact information, and social security number.
02
Have any supporting documentation ready, such as identification cards or proof of income.

Understand the purpose of PHSS:

01
PHSS stands for Public Health Service System, which includes programs like Medicaid and CHIP.
02
Familiarize yourself with the specific program you are applying for and its eligibility requirements.

Research the application process:

01
Visit the official website of the program you're applying for to access the PHSS application form.
02
Read through the instructions carefully to understand what information is required and how to fill out each section.

Start filling out the application:

01
Begin by providing your personal details, following the guidelines provided (e.g., use black ink, write in block letters).
02
Take your time to ensure accuracy and completeness. Double-check the information before moving on to the next section.

Provide requested documentation:

01
Attach any necessary supporting documents as required by the application form (e.g., copies of identification, proof of income).
02
Ensure that all attachments are legible and clearly labeled.

Review and submit the application:

01
Go through the entire application form again, verifying that all fields are completed correctly.
02
Look for any errors or missing information and make corrections as needed.
03
Once you are confident that everything is accurate and complete, sign and date the application form.
04
Follow the instructions on how to submit the form, whether it's mailing it or submitting it online.

Who needs PHSS:

Individuals with low income:

01
PHSS programs often target individuals and families with limited financial resources.
02
These programs aim to provide affordable or free healthcare services, including medical care, prescription drugs, and preventative care.

Children and young adults:

01
Many PHSS programs specifically cater to the healthcare needs of children and young adults.
02
Programs like Medicaid and CHIP offer comprehensive coverage for eligible children, ensuring they receive necessary medical attention.

Pregnant women and new mothers:

01
PHSS programs prioritize the health and well-being of pregnant women and new mothers.
02
They provide access to prenatal care, maternity services, and support for newborns.

Seniors and individuals with disabilities:

01
PHSS programs often offer assistance and healthcare services for seniors aged 65 and older.
02
They also cater to individuals with disabilities, providing necessary medical support and specialized care.
Remember, it is crucial to check the specific eligibility requirements and guidelines of the program you're interested in to determine if you or someone you know qualifies for PHSS.
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PHSS stands for Public Health and Safety Surcharge.
Any business or individual who engages in activities that impact public health and safety may be required to file PHSS.
PHSS can be filled out online through the designated government website or through a physical form that can be submitted by mail.
The purpose of PHSS is to fund public health and safety initiatives and programs that benefit the community.
PHSS requires information on the nature of the activities impacting public health and safety, as well as details on the annual revenue generated from these activities.
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