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SELF-SERVICE PORTAL

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Financial Information

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How many adults are in your household?*
Is anyone age 60 or older?*
How many children are in your household?*
How much total money (before taxes) did all of the people in your household get last month?*
How much cash does the household have on hand? Include cash, money in checking accounts and saving accounts, etc.*
How much does the household pay for medical expenses monthly?*
Are any household members United States Citizens?*
If not, does anyone who is not a US Citizen have legal documentation?*
Does anyone have a disability? *
Is anyone pregnant?*
Is anyone in the household enrolled in Medicare?*
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