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Download the Catastrophic Illness in Children Relief Fund (CICRF) application, forms, information, and more

Forms and other CICRF information in English and Spanish

For assistance call the Catastrophic Illness in Children Relief Fund at (800) 882-1435 or (617) 624-6060. TTY users, call (617) 624-5992.

Learn more about Catastrophic Illness in Children Relief Fund.

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Table of Contents

CICRF application

CICRF Application for Assistance (DOC 121 KB)
Solicitud de ayuda (DOC 125 KB)

Spanish Application Form

Vehicle Purchase and Home Modification forms

Home Modification Statement (DOC 40.5 KB)
Declaración de Modificación del Hogar (DOC 40.5 KB)

Spanish Home Modification Statement

Vehicle Purchase Statement (DOC 41.5 KB)
Declaración de Compra del Vehículo (DOC 43.5 KB)

Spanish Vehicle Purchase Statement

Eligible expenses

Download a list of eligible expenses (DOC 43 KB)
Descargue una lista de gastos admisibles (DOC 50 KB)

Documentation needed

CICRF Documentation of family income (DOC 59 KB)
CICRF Documentation of family expenses (DOC 61.5 KB)

CICRF informational handout

CICRF Flyer - Information about the Fund (DOCX 118.01 KB)

Annual report

The Catastrophic Illness in Children Relief Fund Annual Report (DOC 4.28 MB)
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