Before Applying
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Qualification Requirements
To qualify for service an individual:
1. MUST be a resident of Hennepin or Washington County
2. MUST be Blind or Disabled or 65 years or older
3. MUST show financial need. Your household income for the number of persons in your household cannot exceed the below schedule.
Number of Persons Total
In Household Annual Income*
1 $15,060
2 $20,290
3 $25,520
4 $30,750
5 $35,980
6 $41,210
7 $46,440
8 $51,670 *2017 Federal Poverty Guideline
4. MUST not have any other pet currently enrolled in the program
Requirement 1: Proof that you reside in Hennepin or Washington Counties.*** You MUST provide proof by sending a copy of ONE of the below.
A. Driver’s license, Passport or picture ID with your current address in Hennepin or Washington Counties
B. Utility bill or Bank Statement showing your name on the account and your current address in Hennepin or Washington Counties
C. Social Security Disability (SSD or SSDI) or Supplemental Security Income (SSI)
Award Letter or Bank Statement showing your current address in Hennepin or Washington Counties
D. Major VA Disability Award Letter showing your current address in Hennepin or Washington Counties
Requirement 2: Proof that an adult individual is Blind, Disabled or 65 or more years old.
*** You MUST provide proof by sending a copy of ONE of the below.
A. Picture ID showing your birthdate showing your age as 65 years or older
B. Birth Certificate showing your age as 65 years or older
C. Driver’s license with birthdate showing your age as 65 years or older
D. Passport showing your age as 65 years old or older
E. Social Security Disability (SSD or SSDI) or Supplemental Security Income (SSI)
Award Letter or Bank Statement showing Direct Deposit of SSD or SSI
F. Major VA Disability Award Letter equal to or greater than 50%
Requirement 3: Proof that an adult individual is in need of subsidized veterinary service
*** You MUST provide proof that you are enrolled in ONE of the following programs and that your total household income meets the guidelines in the table at the beginning of this section by sending a copy of one of the below.
A. Supplemental Security Income (SSI) Award Letter or bank statement showing direct deposit of SSI.
B. Medicaid (Minnesota Medical Assistance) - Include a copy of your Minnesota Health Care Program Membership Card.
Requirement 4: This application must be filled out completely and submitted with all of the supplemental materials
1. MUST be a resident of Hennepin or Washington County
2. MUST be Blind or Disabled or 65 years or older
3. MUST show financial need. Your household income for the number of persons in your household cannot exceed the below schedule.
Number of Persons Total
In Household Annual Income*
1 $15,060
2 $20,290
3 $25,520
4 $30,750
5 $35,980
6 $41,210
7 $46,440
8 $51,670 *2017 Federal Poverty Guideline
4. MUST not have any other pet currently enrolled in the program
Requirement 1: Proof that you reside in Hennepin or Washington Counties.*** You MUST provide proof by sending a copy of ONE of the below.
A. Driver’s license, Passport or picture ID with your current address in Hennepin or Washington Counties
B. Utility bill or Bank Statement showing your name on the account and your current address in Hennepin or Washington Counties
C. Social Security Disability (SSD or SSDI) or Supplemental Security Income (SSI)
Award Letter or Bank Statement showing your current address in Hennepin or Washington Counties
D. Major VA Disability Award Letter showing your current address in Hennepin or Washington Counties
Requirement 2: Proof that an adult individual is Blind, Disabled or 65 or more years old.
*** You MUST provide proof by sending a copy of ONE of the below.
A. Picture ID showing your birthdate showing your age as 65 years or older
B. Birth Certificate showing your age as 65 years or older
C. Driver’s license with birthdate showing your age as 65 years or older
D. Passport showing your age as 65 years old or older
E. Social Security Disability (SSD or SSDI) or Supplemental Security Income (SSI)
Award Letter or Bank Statement showing Direct Deposit of SSD or SSI
F. Major VA Disability Award Letter equal to or greater than 50%
Requirement 3: Proof that an adult individual is in need of subsidized veterinary service
*** You MUST provide proof that you are enrolled in ONE of the following programs and that your total household income meets the guidelines in the table at the beginning of this section by sending a copy of one of the below.
A. Supplemental Security Income (SSI) Award Letter or bank statement showing direct deposit of SSI.
B. Medicaid (Minnesota Medical Assistance) - Include a copy of your Minnesota Health Care Program Membership Card.
Requirement 4: This application must be filled out completely and submitted with all of the supplemental materials
After Application Has Been Submitted
Once your application materials have been submitted and reviewed you will be contacted by the ACF Coordinator.
If approved: * You will be contacted by the ACF Coordinator, assigned an ACF client number, and given information to contact the appropriate veterinary member clinic. * It is up to you to contact the veterinary member clinic, set up an appointment, and arrange for your own transportation. If NOT approved: The Coordinator will contact you with the reason you were not approved. You may re-apply if appropriate. REMEMBER *** EVERY CLIENT NEEDS TO SUBMIT AN APPLICATION AND SUPPORTING DOCUMENTATION ANNUALLY *** |
What you need to know: The ACF veterinary member clinics receive no compensation from any government program or a tax deduction for the services and goods they donate. The ACF veterinary member clinics have limited resources and occasionally a referral cannot be made even when a person qualifies. Each veterinary member clinic retains the right to refuse a referral.
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