PHP Assistance Fund Application

Purpose: The PHP Assistance Fund is created to provide financial assistance for participants enrolled in the Pennsylvania Physicians’ Health Program who have demonstrated financial assistance need for fees associated with: case initiation, monitoring, advocacy, testifying, drug testing, treatment, and evaluation.

PHP Assistance Funds cannot be utilized to pay for evaluation or treatment services associated with non-profit providers who have the ability to fundraise through their 501-c-3 IRS designation.

Eligibility: PHP participants wishing to apply for assistance must meet the following criteria:

1. Participants must be enrolled in the PHP Program.
2. Participants must have a demonstrated financial need.
3. Participants must complete an online PHP Assistance Fund application and provide the required collateral materials. Incomplete applications will not be accepted.

Guidelines:

1. Please note that the penalty for submission of fraudulent information will be immediate cessation of financial assistance.
2. Assistance is provided for a limited time.  If additional assistance is needed, another application will need to be completed.
3. Applications will be reviewed and approved by the Sr, Director of Finance and Operations and PHP Staff.
4. Required Supporting Documents include:
   • Federal tax information or tax returns including IRS W-2 information, for you (and your spouse, if you are married), and for your parents if you are a dependent student
   • Records of your untaxed income, such as child support received, interest income, and veterans noneducation benefits, for you, and for your parents if you are a dependent student.
   • Information on cash; savings and checking account balances; investments, including stocks and bonds and real estate (but not including the home in which you live) for your parents if you are a dependent student
5. Questions regarding the fund or application process may be directed to the PHP at (717) 558-7819, Monday through Thursday, from 8:00 a.m. to 4:00 p.m.