Begin your application process for the Catastrophic Illness in Children Relief Fund (CICRF).
- This page, Apply to CICRF, is offered by
- Division for Children & Youth with Special Health Needs
- Bureau of Family Health and Nutrition
Apply to CICRF
Contacts
Catastrophic Illness in Children Relief Fund (CICRF)
The Details
What you need
The online application provides spaces for you to upload documentation of your income from all sources and proof of payment of medical expenses for your child. Before applying to CICRF, we strongly recommend that you review our Eligibility Guidelines.
By signing and uploading releases to REDCap, CICRF can request additional information on your behalf. For example, CICRF can request hospital discharge summaries, outpatient dates of service, and public benefits information.
We strongly recommend that you review the application before submitting your application to determine what paperwork you will need to submit. While reviewing the application, you should save your application so that you may return to it later. After gathering all required documentation and information to apply to CICRF, return to your saved application to upload documents, complete the rest of the application, and submit your application to the fund.
How to apply
CICRF has created an online application to make it easier for families to apply to the Fund and upload all necessary income and expense documentation. The information on the application is needed for CICRF to determine if you are eligible for financial reimbursement. The application is designed so you do not have to do it all at one time. This will allow you to put together all the documents you need to upload.
The application consists of 2 pages. You must enter information into all required fields before moving to the second and last page.
- The first page will ask you to enter information about you and your child. This includes names, addresses, dates of birth, health insurance, your child's diagnosis, demographics (your child's race and ethnicity), information about any hospitals your child may have used, your expenses, and income. You will also be asked to upload proof of your income (W-2s, 1099s, award statements, etc.) and upload proof of your expenses (invoices, signed contracts or agreements, payment receipts, bank statements, etc.).
- The second page will ask you to read and sign a consent form.
More info
To learn more about income sources to disclose when applying to CICRF, read our “CICRF Documentation of family income” guide, which can be found in our “Downloads” section.
For general information about documentation required for reimbursable expenses, read our “CICRF Documentation of family expenses” guide, which can also be found in our “Downloads” section.
Downloads
Open PDF file, 830.74 KB,
CICRF Documentation of family income
(English, PDF 830.74 KB)
Open DOCX file, 1.53 MB,
CICRF Documentation of family income
(English, DOCX 1.53 MB)
Open PDF file, 71.36 KB,
CICRF Documentation of family expenses
(English, PDF 71.36 KB)
Open DOCX file, 13.64 KB,
CICRF Documentation of family expenses
(English, DOCX 13.64 KB)
Contact
Address
Massachusetts Department of Public Health
250 Washington St., 5th Floor, Boston, MA 02108-4619
Fax
(857) 323-8322