- You are under 18 years of age, homeless, in foster care or otherwise lacking any parental or other familial support, and your income is less than 150% of the U.S. poverty level.
- You cannot care for yourself because you suffer from a serious, chronic disability and your income is less than 150% of the U.S. poverty level.
- You have, at the time of the request, accumulated $25,000 or more in debt in the past 12 months as a result of unreimbursed medical expenses for yourself or an immediate family member, and your income is less than 150% of the U.S. poverty level.
The following documentary evidence can be used to demonstrate that you meet any of the above conditions when you apply:
- Affidavits from community-based or religious organizations to establish your homelessness or lack of parental or other familial financial support.
- Copies of your tax returns, banks statement, pay stubs, or other reliable evidence of income level. Evidence can also include an affidavit from the applicant or a responsible third party attesting that you do not file tax returns, have no bank accounts, or have no income to prove income level.
- Accept copies of your medical records, insurance records, bank statements, or other reliable evidence of unreimbursed medical expenses of at least $25,000.
- Address any factual issues through a Request for Evidence
