TX HHS Form 3033. Hemophilia Assistance Program (HAP) Application

The TX HHS Form 3033, Hemophilia Assistance Program (HAP) Application, is a crucial document for individuals seeking financial assistance through the Hemophilia Assistance Program. This form helps applicants provide essential information to determine their eligibility for the program.

This application requires completion of all fields, including applicant information such as name, date of birth, social security number (if available), and contact details. Additionally, proof of residency and income must be submitted, with specific requirements outlined in the form. The Physician Assessment Form is also a necessary component for a complete application.

The Hemophilia Assistance Program Application should be used by individuals who require financial assistance to manage their hemophilia-related expenses. This form can only be completed and submitted by eligible applicants, as defined by the program's guidelines. For questions about the application process or requirements, please call 800-222-3986.