The Hemophilia Foundation of Greater Florida designed the Emergency Financial Assistance Program (EFAP) to help people with bleeding disorders. Hemophilia Foundation Emergency Financial Assistance Program funds are intended for a crisis situation or unforeseen emergency. All requests for assistance with rent, utilities, mortgage, medical bills and medical equipment must be in the name of the person with the bleeding disorder, unless the person with the bleeding disorder is under the age of 18. Therefore, the names of family members and other relatives are prohibited from financial assistance.
Emergency Financial Assistance Form
All fields marked with an asterisk are required. Make sure to attach supporting documents (see details on this page) when applying.
Before filling out the application, please keep the following mind:
- The Hemophilia Foundation of Greater Florida Emergency Financial Assistance Program is for people with bleeding disorders and their families in emergency situations only - such as rent, some medical assistance, Utility Bills, Mortgages, Food, and Transportation for medical or chapter appointments. The HFGF does not assist with the following request:
- Auto Tags/licenses
- Auto Payments/Repairs/Rentals
- Auto Tires
- Credit Cards (debts or payments)
- Cable TV/internet
- Cell Phones/Home Phones
- House repairs/modifications/renovations
- Insurance Premiums/ Homeowners Insurance/Fees/Dues
- Legal Fees
- Clients receiving treatment at an HTC must be referred to the HFGF by the HTC.
- The person seeking assistance must submit the name(s) of person(s) living in the household affected with a Bleeding Disorder & state the Bleeding Disorder type before HFGF will review the financial request.
- The form must be completed and a detailed written explanation of the reason needing financial assistance is required with the application. Failure to complete the forms will delay or terminate the financial assistance.
- Household income and gross earnings must be disclosed such as:
- Most recent tax return
- Bank statement
- A copy of your 2 most recent pay stubs
- A copy of all government assistance received (SSI, SSDI, Section 8, and food stamps)
- Please include a copy of the bill or invoice that you are requesting for payment. All payments will be made directly to the service provider or creditor. payments will be paid directly to the applicant.
- Financial assistance cannot exceed $500 per year (family) during a 12 month period.
- Your request will be evaluated within 7 days of receipt of your completed application.
- The Foundation reserves the right to refuse financial assistance. If a client’s request is denied, you have the right to appeal.
* The applicant requesting bill, mortgage/rent assistance must have their name on the bill/lease/statement.
Documents needed for every application
- Copy of every working person in the households paycheck stub
- Copy of the bill in which you are requesting assistance with paying
- Any other documents that support your request
Additional documentation for dental assistance
- Letter from your HTC
- Treatment plan for services
Additional documentation for rental assistance
- Current lease agreement