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RURAL HEALTH, INC. APPLICATION FOR SLIDING FEE DISCOUNT Appendix B Name:___Date of Birth___ Address:___ Street City State Zip Code Phone:___ Medicare: Y/N Medicaid: Y/N Insurance: Y/N Married: Y/N

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How to fill out application for sliding fee

01

Obtain the sliding fee application form from the appropriate organization or agency.

02

Fill out all required personal information such as name, address, contact details, and household income.

03

Provide any necessary documentation to support your income level, such as pay stubs or tax returns.

04

Submit the completed application form and documentation to the designated office or individual for review.

Who needs application for sliding fee?

01

Individuals or families who are in need of financial assistance for medical or healthcare services may need to fill out an application for sliding fee.

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What is application for sliding fee?

An application for sliding fee is a form that individuals can submit to determine their eligibility for reduced fees based on their income.

Who is required to file application for sliding fee?

Individuals who are seeking financial assistance or reduced fees for services may be required to file an application for sliding fee.

How to fill out application for sliding fee?

To fill out an application for sliding fee, individuals typically need to provide information about their income, household size, and any expenses.

What is the purpose of application for sliding fee?

The purpose of an application for sliding fee is to assess an individual's financial situation and determine if they qualify for reduced fees based on their income.

What information must be reported on application for sliding fee?

Information that may need to be reported on an application for sliding fee includes income, household size, and any expenses that the individual incurs.

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