In order to receive services the following criteria must be met:
- Uninsured
- Income level below 200% of the Federal Poverty Guidelines
- Lebanon County Resident for at least 90 days with a photo ID
Register by bringing income verification and photo ID with Lebanon County address.
Registration must be done in person by patient seeking services or care.
Patients must register ahead of time to receive an appointment. No telephone registrations.
2016
| Persons in Family | 200% FPL |
| 1 | $23,540 |
| 2 | $31,860 |
| 3 | $40,180 |
| 4 | $48,500 |
| 5 | $56,820 |
| 6 | $65,140 |
| 7 | $73,460 |
| 8 | $81,780 |
* For families with more than 8 persons, add $4,060 for each additional person
ACCEPTABLE PROOFS OF IDENTIFICATION
- Copy of valid PA driver’s license or PA ID card (can also serve as proof of residence if address is current)
- Copy of passport
- Copy of Alien Registration card
ACCEPTABLE PROOFS OF RESIDENCY
- Copy of valid PA driver’s license
- Copy of utility bills
- Copy of rent receipt of written statement from a non-relative landlord
- Copy of mortgage receipt
- Envelope of mail postmarked within the last 3 months, with applicant’s name and current address
ACCEPTABLE PROOFS OF INCOME
(Please bring a copy of each type of income)
- Pay stubs, checks, aware letters from last 30 days
- Employer’s written statement including employer’s name, address, phone number, and how much was earned during the last 30 days
- Last year’s tax return or business records and receipts if self-employed
- Social Security award letter, current check, or direct deposit from bank statement
- Worker’s Comp check stub or current award notice
- Award statement for unemployment
- Pension check or statement
- Bank statement showing interest for bank accounts
- Educational loans or grants
- Written statement from person or agency providing money or making payments for you