The Cancer Foundation of Northeast Georgia PO BOX 49309 Athens GA 30604
3320 Old Jefferson Rd Building 700 click here for map
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Financial Assistance Program (FAP)
Eligibility Criteria:
Applicants must meet the following qualifications to be considered for the FAP.
- Reside in the CFNEGA service area which includes: Banks, Barrow, Clarke, Elbert, Franklin, Greene, Habersham, Hart, Jackson, Madison, Morgan, Oconee, Oglethorpe, Putnam, Stephens,Taliaferro, and Walton counties.
- Must be at least 18 years old.
- Have a cancer diagnosis as certified by healthcare provider.
- Be receiving active chemotherapy and/or radiation, hormone therapy, or be within a 3 month post-treatment period.
- Have household* income less than or equal to 200% of the 2011 Federal Poverty Limits.
| Household Size |
Gross Monthly Income |
Gross Annual Income |
| 1 |
$1,815.00 |
$21,780.00 |
| 2 |
$2,452.00 |
$29,420.00 |
| 3 |
$3,088.00 |
$37,060.00 |
| 4 |
$3,725.00 |
$44,700.00 |
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*From Ga Dept of Community Health Financial Limits
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| 5 |
$4,362.00 |
$52,340.00 |
*Household is defined as any persons residing together related by blood, marriage, commitment, or legal adoption that are dependent on the combined income.
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Must be able to provide proof of income for each person in household over 18 years. Choose one of the following items for proof of income:
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Bank statements from the last two months
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Pay stubs from the last two months
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Social Security benefit letter
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Social Security 1099
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Notarized statement from employer
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Copy of Social Security check
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If a patient has no income
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Have resources** totaling less than
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Demonstrate attempts to apply for other forms of community financial assistance.
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Financial assistance will be considered for applicants that meet the aforementioned qualifications
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Financial assistance will be awarded to assist with the following expenses:
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Utility bill(s) including gas, electric, water, propane and phone. Utility bills must be due within a week of the financial request or past due.
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Rent/mortgage payments must be due within a week of the financial request or past due.
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Insurance Premiums (COBRA included)
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Health insurance co-payments
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Nutritional Assistance
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Durable medical equipment not covered by insurance, i.e., walkers, wheelchairs, bedside toilets, etc.
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Pharmacy prescription costs
- Transportation cost (gas cards)
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Payments will be made directly to company owed. Therefore applicants must supply copies of the bill, late notice, mortgage statement, statement from landlord and his/her contact information, or any additional information necessary for grant payment.
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There is an annual cap of $500.00 per applicant (Amount may vary based on availability of funds)
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Applicants must wait one year to reapply for financial assistance.
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Applicants must be referred by a physician, physician assistant, nurse, social worker, or patient account representative.
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Only completed applications will be considered.
Referral:
The Financial Assistance Program is based on a referral system. A patient must be referred by a social worker, nurse, physician, physician assistant, or patient account representative.
Click to download referring professional form.
Application:
Referring professionals are asked to mail a completed application to the following address or fax number:
The Cancer Foundation of Northeast Georgia P.O.Box 49309 Athens, GA 30604-9309 Or Fax to (706) 353-4353
Click to download Application Letter.
Click here to download Application Form.
Click here for the CFNEGA Financial Distress Screening.
Application Process:
- Applications are reviewed by The Cancer Foundation’s staff for completeness and whether the patient meets eligibility criteria.
- If the patient is approved for assistance the referring professional is notified by phone or email regarding the amount of assistance.
- Financial Assistance checks are made directly to the creditor owed.
What we fund:
Financial assistance will be awarded to assist with the following expenses:
- Past due gas, electric, water, propane and phone
- Past due rent/mortgage
- Insurance Premiums (COBRA included)
- Health insurance co-payments (does not include deductibles)
- Nutritional Assistance
- Durable medical equipment not covered by insurance, i.e., walkers, wheelchairs, bedside toilets, etc.
- Pharmacy prescription costs
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