Emergency Medical Service Funding Assistance Program Application 2025

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  1. Click ‘Get Form’ to open the Emergency Medical Service Funding Assistance Program Application in the editor.
  2. Begin by filling out the 'Ambulance Service Provider Information' section. Enter your licensed provider name, provider number, complete mailing address, telephone number, Federal Employer ID Number, and email address.
  3. Next, move to the 'Certification of Municipality / Contracting Agency(s)' section. Identify all municipalities in your primary service area and ensure each municipality certifies its actual population served and the percentage this represents.
  4. For each municipality, input the Municipal Code, total Population Served by your ambulance service provider, and calculate the Percentage of total population represented. Ensure accuracy as this information is crucial for funding eligibility.
  5. Finally, have the municipal clerk sign and date the form to certify that all provided information is true. If there are multiple municipalities, you can copy this page as needed.

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Emergency Medical Services, more commonly known as EMS, is a system that responds to emergencies in need of highly skilled pre-hospital clinicians.
EMS are primarily funded at the local level and often severely underfunded. Administration, management, and oversight of EMS systems vary greatly but typically involve collaboration among multiple sectors.
An Execution management system, or EMS, is an application utilized by traders designed to display market data and provide seamless and fast access to trading destinations for the purpose of transacting orders.
In the typical scenario, EMS responds to a medical need, the patient is assessed, treated and transported to the ED, insurance is billed, the service is covered (decreasing the patients out-of-pocket costs), and the ambulance agency is generally compensated for the care it appropriately provided.
The Maddy EMS Fund (Original and Supplemental Assessment) are funded through revenues generated from local penalty assessments on fines and forfeitures for various criminal offenses and motor vehicle violations, including a portion of traffic school fees, as identified below.