Once you have obtained the required documentation, please call (863)471-1870 to schedule an eligibility appointment.
Photo Identification (provide one of the following):
State issued Driver’s License
State issued ID
Proof of Address (provide one the of the following):
Utility Bill (lights, cable, water)
Proof of any/all income for the most current (8) eight week period for all household members:
Social Security Benefits
Food Stamp Benefits
If you are self-employed you must provide:
- Bank statements for the previous (3) three months for all household members and/or
- Payment statements from anyone who has paid you, within the last (3) three months
If anyone is giving you money, providing you room and board or paying any of your bills, that person must complete:
- A notarized Statement of Support (included in patient application). STCC does provide a free notary service on-site by appointment for this purpose.
Most recent Tax Return (1040, 1040EZ, 1040A, Schedule C):
- If you do not file taxes or do not have access to your tax return, and you wish to be eligible for the Prescription Assistance Program you will be required to submit an official Tax Return Transcript or Verification of Non-Filing.
- An official Tax Return Transcript/Verification of Non-Filing can be easily obtained by logging onto http://www.irs.gov/Individuals/Order-a-Transcript or by submitting Form 4506-T to the IRS. This form can be obtained from the IRS website or STCC. If needed, STCC staff can fax this form to the IRS for you.
Medicaid Determination Letter
- EVERYONE must apply for Medicaid with the Department of Children & Families. Please note that you WILL NOT be eligible for the Prescription Assistance Program until the Medicaid Determination letter is submitted.
- STCC is an ACCESS site. You may apply at STCC at your convenience or apply online at http://www.myflorida.com/accessflorida/ or call (800) 762-2237.