873 STATE STERILIZATION FUND 2026

1. Click ‘Get Form’ to open the 873 STATE STERILIZATION FUND in the editor.
2. Begin by entering the client's name, date of birth, and family size in the designated fields. Ensure that this information is accurate as it determines eligibility.
3. Complete the income section by providing gross monthly income and indicating where the client falls on the sliding fee scale (0% or 25%).
4. Fill out the Consent to Sterilization section, ensuring all signatures are obtained. This includes both the client’s and the staff member's signatures.
5. After sterilization, submit hard copies of required documents for reimbursement. Use our platform to easily compile these documents into a single PDF for submission.

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