This is a Sample Application for Special Care for Children Assistance Plan. Assistance under this plan will be provided if a child, up to age 23, has a mental, emotional, or physical handicap requiring treatment at the recommendation of a physician in an eligible residential care facility, day school, or clinic.

To view the rest of the content please click here to login, or to learn about subscription options.

Form Specifications:

Dimensions	Designed for Letter Size (8.5" x 11")
Printer compatibility	Designed to print on all ink-jet and laser printers
Editable	MS Word 97 or later
Format
Platforms
Usage	Unlimited number of prints
Download time	Less than 1 minute (approx.)

© 2001-2010 HR & Benefits Essentials - All rights reserved - Terms of Use
HR & Benefits Essentials and the HR & Benefits Essentials logo are trademarks or service marks and are the property of their respective owners and should be treated as such. Program terms and conditions, pricing, features and service options are subject to change without notice.