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Your gross business income before deductions and expenses is used to determine eligibility for this program.. State issued driver s license or photo ID 1. Birth certificate 3. Immigration and Naturalization Service INS 2. Application for Sliding Fee Program We are pleased you have selected the Community Health Center of Buffalo Inc. CHCB for your healthcare needs. 2016 Date Patient Name Last First SS -- Address City Zip Date of Birth -- Phone/Cell -- Single Married Divorced Widow Please List...
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How to fill out application for sliding fee

01
Gather all necessary documents such as proof of income, proof of address, and identification.
02
Obtain a copy of the sliding fee application form from the relevant organization or website.
03
Read the instructions on the application form carefully.
04
Provide accurate and complete information in each section of the application form.
05
Attach the required documents to the application form.
06
Review the completed application form and documents for any errors or missing information.
07
Submit the application form and all supporting documents to the designated application submission location.
08
Wait for the organization to process your application and notify you of their decision.
09
If approved, carefully review the terms and conditions of the sliding fee program and adhere to them.
10
If denied, follow the instructions provided by the organization for any further steps or appeals.

Who needs application for sliding fee?

01
Individuals and families with limited financial resources.
02
Those who are unable to afford the full cost of services or programs.
03
People who meet the income requirements set by the organization offering the sliding fee program.
04
Those seeking financial assistance for medical, educational, or other essential services.
05
Individuals who believe they may be eligible for discounted or reduced-cost services based on their income level.
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Application for sliding fee is a form used to request reduced fees based on a person's income.
Individuals who meet certain income criteria may be required to file an application for sliding fee in order to receive reduced fees for services.
To fill out an application for sliding fee, individuals must provide information about their income, household size, and any other relevant financial information.
The purpose of the application for sliding fee is to ensure that individuals with lower incomes are able to access services at a reduced cost.
Information such as income, household size, and other financial details must be reported on the application for sliding fee.
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