Surgical Assistance Fund 2026

1. Click ‘Get Form’ to open the Surgical Assistance Fund application in the editor.
2. Begin by entering the date of your application at the top of the form. This is essential for processing your claim.
3. Fill in your rank, unit, and retirement date if applicable. Ensure that you provide accurate information as it verifies your eligibility.
4. Complete your personal details including your name, last four digits of your Social Security number, address, and telephone number.
5. Provide patient information such as their name, age, relationship to you, and if applicable, their date of birth.
6. Indicate whether the surgical procedure was a result of a Line of Duty (LOD) injury by checking 'YES' or 'NO'.
7. Clearly state the name of the surgical procedure performed.
8. Attach one of the required documents: a signed statement from the doctor or a GHI/Medicare benefit form that includes necessary details about the procedure.
9. Finally, sign the application at the bottom to confirm all information is accurate before submitting it for review.

Start filling out your Surgical Assistance Fund application today using our platform for free!