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Get Hlth 5355 2021-2024

And receive a Confirmation of Assistance letter? Is your net income for last year or this year at least 10% less than your income from two years ago? If you answered yes to these questions, use this form to apply for additional Fair PharmaCare assistance for this year. IMPORTANT: To request increased assistance for this year, submit your application and supporting documents no later than December 31. You cannot request more assistance for a previous year. Please read all information.

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