HCHD 283117 2010-2024 free printable template

FINANCIAL ASSISTANCE APPLICATION INSTRUCTIONS There is No Fee for a Gold Card. If you are asked to pay for a Gold Card please report this to 713 566 6277. Applying for Financial Assistance Call 713 566 6509 to schedule an appointment or or Drop off to the nearest Eligibility Center Mail to HCHD Financial Assistance Program P. O. Box 300488 Houston TX 77230 Please provide copies of the following papers Identification ID One for you and your spouse State...

How to fill out harris county gold card form

How to fill out a gold card application:

1. Gather all necessary personal information such as name, address, contact details, and identification documents.
2. Fill out the required sections of the application form accurately and legibly.
3. Provide any additional supporting information or documents that may be required, such as proof of income or employment details.
4. Ensure that all provided information is truthful and complete.
5. Review the completed application form for any errors or omissions before submitting it.

Who needs a gold card application:

1. Individuals who are interested in obtaining a gold card membership or benefits.
2. Those who meet the eligibility criteria for a gold card and wish to take advantage of the privileges it offers.
3. People who frequently utilize services or facilities associated with gold card membership, such as exclusive events, discounts, or access to specific establishments.

Video instructions and help with filling out and completing gold card application

Instructions and Help about harris health gold card form

Put your name in this field now put your unmarried name if you're married in this field this is the field for your street address where you receive bills in this field you should put your apartment number for the place that you live in this Bill's right your County which for most people will be Harris in this field right your city which for most people will be Houston here you should write TX for Texas the state you live in here you should write your zip code you should look at a bill that has been sent recently to your home and look for this five-digit number somewhere on that bill here write your home telephone number which for most people are a cell phone if you have a phone number where you can be reached at work write it here, but many people will not have anything to put here you may specify your marital status as single married separated divorced widowed or common-law next specify whether you've been to bend tub Quinton main or LBJ hospitals by marking yes or no here if you happen to one of these hospitals then write the date here in this table enter the names of all the members of your household start by entering people's last names in the column here you should enter the first names of your family members in this column here you should specify the relationship for example father brother and uncle sister or mother enter the date of birth of each of your family members in this column now write the social security number of each family member in this column here you should enter the race of each family member for example Burmese Nepalese Congolese Iraqi and a richer Ian here you should specify the gender of each family member either select male or female in this column next select whether each member of your family is employed by selecting yes or no in this column next specify the legal status of each member in your home this may be citizen legal resident which is common for many refugees undocumented worker work permit worker sponsored or visa which is also common for many refugees in this table you should enter the names of people in your home who work start by entering their name in this column then specify the company that they work for and how often they get paid for example bi-weekly twice monthly or monthly and then enter the amount that they get paid here is anyone in your home pregnant if so mark yes and if not mark know if someone is pregnant in your home, and you marked yes then put their name and the expected delivery date in this field is anyone in your home in sure if so mark yes and if not mark know if you marked yes and someone has health insurance write their name here and then write the name of the company and the member number here finally you should complete the application by signing in this field and then writing today's date in this field

People Also Ask about harris health gold card application

What is the Texas Gold Card law?

Beginning Oct. 1, 2022, certain provisions of Texas House Bill 3459, as known as the “Texas gold card bill,” take effect. This new law reduces prior authorization requirements helping patients get the treatment they need when they need it.

Where can I go to apply for a gold card?

There are two ways to apply for the Gold Card during the COVID 19 pandemic and those are: Visit a Harris Health Eligibility Center to pick up an application. You can have an application mailed to you by contacting the Eligibility Information Line at 713.566. 6509.

How do you get a gold card in Texas?

How do I get the gold card in Texas? There are two ways to apply for the Gold Card during the COVID 19 pandemic and those are: Visit a Harris Health Eligibility Center to pick up an application. You can have an application mailed to you by contacting the Eligibility Information Line at 713.566. 6509.

How do you qualify for a gold card in Texas?

Provide: Texas I.D. or drivers license stating the person lives in Harris County. Social Security Card. Citizenship(Passport or Birth Certificate) or Green Card. Proof of income (1 months check stubs) Any bills or bank statement (within 60 days) Income tax (if necessary) Medicaid or CHIP card (if necessary)

How do you qualify for a gold card in Texas?

Harris Health Financial Assistance Program (Gold Card) Texas I.D. or drivers license stating the person lives in Harris County. Social Security Card. Citizenship(Passport or Birth Certificate) or Green Card. Proof of income (1 months check stubs) Any bills or bank statement (within 60 days) Income tax (if necessary)

What is the number for Harris Health Gold Card?

If you have any questions, call the Eligibility Call Center at 713-566-6509.

How long does it take to get gold card?

It can take anywhere from a few minutes to 14 days to get approved for the Delta Gold Card. Certain applicants may be approved instantly if they match the Delta Gold Card's exact criteria.

How long does it take to get Taiwan Gold Card?

The application can take over 60 business days assuming you have all the proper documentation submitted. If you hold a 60-days visa or are visa-free, or you cannot obtain the Taiwan Employment Gold Card within the time limit, you will still need to leave the country and re-enter.

How much income required for Taiwan Golden visa?

Must meet ONE of the following requirements: 1. Previously or currently holding a position in a foreign state or in the R.O.C. with a most recent monthly salary of at least NT$160,000.

For pdfFiller’s FAQs

What is gold card application?

A Gold Card application is an application for a special type of credit card that offers various benefits and rewards to its holders. Gold Cards are usually issued by major credit card companies and offer perks such as cashback, discounts, and exclusive access to certain services. The eligibility criteria for a Gold Card are usually higher than those for regular credit cards, and applicants must have a strong credit score and a good financial history.

Who is required to file gold card application?

All U.S. permanent residents are required to file a gold card application.

How to fill out gold card application?

1. Gather your personal information. You will need to provide your full name, address, Social Security number, and date of birth. 2. Choose a card issuer. You can apply for a gold card through a bank, credit union, or other credit card issuer. 3. Complete the application. Provide all the required information, including your income, employment history, and other financial details. 4. Submit your application. Once you’ve filled out the application, submit it to the card issuer. 5. Wait for a response. The card issuer will review your application and make a decision. If approved, you’ll receive your gold card in the mail.

What is the purpose of gold card application?

The purpose of a gold card application is to apply for a higher level of credit card that typically offers more rewards and benefits than a standard credit card. Gold cards typically come with a higher annual fee and higher credit limit than standard credit cards, but can provide greater rewards and benefits such as travel points, cash back, extended warranty coverage, and more.

What information must be reported on gold card application?

The information required to complete a gold card application typically includes: • Name, date of birth, and contact details • Current address and length of time at the address • Employment status and income • Financial information including bank account details • Copies of identification documents such as a driver's license or passport • Any existing credit cards and their limits

When is the deadline to file gold card application in 2023?

The deadline to file for a gold card application in 2023 has not yet been announced. The U.S. Citizenship and Immigration Services (USCIS) typically announces these deadlines one to two months before the start of the filing season.

What is the penalty for the late filing of gold card application?

There is no specific penalty for filing a gold card application late. However, it is important to submit your application as soon as possible so that you can receive the benefits of the gold card in a timely manner.

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