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This document is an application form for patients seeking discounts on dental services based on their income and household size. It requires applicants to provide personal financial information and supporting documents to verify their eligibility for the Sliding Fee Discount Program, which must be renewed annually.

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What is sliding fee application?

A sliding fee application is a financial form used by organizations to determine a customer's fee based on their income and family size, allowing for adjusted rates for services.

Who is required to file sliding fee application?

Individuals or families seeking services that have a sliding fee scale based on income are typically required to file a sliding fee application.

How to fill out sliding fee application?

To fill out a sliding fee application, provide personal information such as name, address, and income details, and submit any required documentation that proves income and household size.

What is the purpose of sliding fee application?

The purpose of the sliding fee application is to assess an individual's ability to pay for services based on their income, ensuring that financial assistance is provided to those in need.

What information must be reported on sliding fee application?

The sliding fee application must report personal information including income, family size, expenses, and any other relevant financial information that helps determine the fee.

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