We proudly offer the opportunity to apply for financial assistance with our health system. If your financial situation meets the criteria set forth by CDP Health, part or all of your account balance may be forgiven.
To process this application, we require:
- The enclosed application completed in its entirety.
- Proof of all income (i.e. Last two pay stubs for any wage earner contributing to household income, SS, SSI, SSDI, Public Assistance, Rental Income, Retirement, Pension, VA Benefits, Unemployment, Workers Comp, Child Support, Alimony, etc.)
- Copy of your most recent 1040 tax return, including all applicable schedules
- If your most recent tax return is not available, then we need one of the following:
- Social Security Awards Letter
- Proof of non-filling from the IRS (call 800-829-1040 to obtain a copy)
- Copy of your property tax assessment statement from county for any owned property
Choose one of the following ways to submit the application:
Download the Financial Assistance Application (above) and fill out the form. When the form is fully completed, save as a new file and upload into the submission box below:
Send via Mail:
Print the Financial Assistance Application (above) and fill out the form. When the form is fully completed, you may return to our office by MAIL:
CDP Health Care System
205 Orchard Drive
Sisseton, SD 57262