As a Federally Qualified Community Health Center (FQHC), FHC offers a sliding scale discount program based on family size and income. 

 

The following information is needed to determine eligibility for FHC's Sliding Scale Discount Program:

1. Information regarding family size.

 

2. Documentation that verifies all sources of income, which includes:

 

a. Wages​

 

  • If you are paid weekly, we will need the last 4 current check stubs.

  • If you are paid bi-weekly, we will need the last 2 current check stubs

  • If you are paid montly, we will need the last current check stub

  • If you receive government benefits, we will need a letter from the Social Security Office of Department of Human Services (DHS) stating your household income.

 

  b. Other Sources of Income

 

  • Social Security Disability Income (SSDi)

  • Temporary Assistance for Needy Families (TANF)

  • Retirement Benefits 

  • FHC's "Declaration No Income" Form

  • Unemployment Compensation 

  • Worker's Compensation 

  • Alimony/Child Support  (Court-order/DHS)

  • VA Benefits 

  • IRS Form W-2

  • IRS Form 1040, 1040A, or 1040EZ

  • Other income source(s)

 

3. Photo ID and address verification

 

  • Current photo ID with address

  • Current photo ID with any utility bill

  • Other documents that verifies place of residency

If you are unemployed and/or have no means of income, you may still qualify for the sliding scale discount program. Please stop by any FHC location and fill out an application today to determine your eligibility.