Application for the Supplement for Handicapped Children Requiring Exceptional Care

You are entitled to this financial assistance if:

• you receive Family Allowance for a child
• you receive the Supplement for Handicapped Children for this child
• this child is under age 18 and has severe and multiple disabilities that prevent him or her from carrying out his or her life habits, or whose medical condition requires specified complex medical care at home. The expected duration of the disabilities or medical care must be for at least one year. We determine your child's eligibility based on certain requirements.

The form includes:

• the application for the Supplement for Handicapped Children Requiring Exceptional Care
• the Consent Regarding the Release of Medical, Psychosocial and Education Related Information.