To be eligible for the OHDAP formulary program, the applicant must:
- Submit a complete application and demonstrate a willingness to sign all forms and to provide necessary documentation.
- Be a resident of Ohio.
- Have a monthly gross income that meets our Financial Eligibility Guidelines (this income amount is adjusted for family size). This form should become available in April of each year. Applicants with an income at or below the federal poverty level are required to have an ODH-Approved Part B Medical Case Manager who can assist them in accessing all eligible services.
- Provide proof of monthly income (for the applicant, as well as the applicant's legal spouse and/or dependents). This includes copies of pay stubs for the most recent 30 consecutive days of employment, Social Security Income award letters, copies of unemployment compensation stubs, etc.
- For the self-employed: provide a copy of an IRS Income Tax Transcript for the most recent tax year. The form to obtain the transcript is Form 4506T and is available at the IRS Web site. Step-by-step instructions are also available by following the IRS transcript request instructions.
Any individual found to be submitting fraudulent information may be expelled from this and other HIV Care Services Section programs.
Complete the application. If you have any questions about how to apply for OHDAP programs, how to complete this application, or any other concern or consideration, please don't hesitate to call us at 1-800-777-4775. This is a toll free number.
On the following pages, you will find the new Ryan White Part B program application. This application represents a great deal of work behind the scenes in the creation of a brand new database. The new system will allow you to complete one application for all Ryan White Part B services.
The form(s) may look different to you, but much of the information is the same. We try to collect only the basic information necessary to enable us to assess your eligibility for the various programs we offer and to enroll you for those services.
Any time you see an asterisk (*) on the form, it means the field is required and that we need the information to enable us to process your eligibility for enrollment. You can also take this form to your case manager and he or she can help you complete it.