Tracking Details

Metrics - Current Month Count

The HFA Board authorized a limited reopening of the Helping Hands program from June 9, 2025, through December 31, 2025. Due to funding limitations and to streamline the process, approved requests will rely on the completion of an online two-part application by either an HTC health care professional or a Member Organization Executive Director/designated staff, and the community member.

Applicants who are approved will receive a $250 prepaid Visa card that will be mailed directly to the address that is provided. Please keep this in mind when working with unhoused individuals.

Due to the limited availability of funding, HFA is only able to approve 20 requests per month, and the portal will close once the funds are depleted each month and reopen on the 1st of the following month.

We realize this is a significant change from previous years funding levels and we will be unable to aid everyone. HFA is continuing to work on increasing the availability of funding for 2025 through the sale of HFA branded items through our matching program from The Alliance Pharmacy.

As a reminder, assistance is limited to $250 one time per year per household.

Visit the website for eligibility requirements details: https://www.hemophiliafed.org/helping-hands

Please contact HFA's Services Team at helpinghands@hemophiliafed.org with questions.

Which Assistance program are you applying for:

Assistance Funds

Are you applying for yourself or on behalf of someone?

Applying for myselfApplying for a family memberApplying for a patient or client

Referrer's Information

Your First Name:

Your Last Name:

Your Phone:

Your Email:

Your Organization Name:

Type of Organization:

Your Position:

Your Title:

We do not accept self-referrals for Emergency Assistance. The referral must be submitted by an Eligible Referrer:

Physician, nurse, or social worker from a Hemophilia Treatment Center

Private physician

Representative from a national, regional, state, or local bleeding disorder organization

Homecare representative of the applicant

Not a relative or employer of the applicant

Stop - Self Referral

Local Support

Many local bleeding disorder organizations have funding to assist community members with unexpected costs associated with having a bleeding disorder and financial, emergency, and disaster assistance and items.

"I have helped the applicant check for other alternative sources including my local bleeding disorder organization and HTC prior to applying for HFA’s Helping Hands program."

YesNo

Please contact the local bleeding disorder organization and treatment center about assistance prior to submitting an application to HFA's Helping Hands program.

Stop - not contacted other sources

Please provide the name of the organization contacted:

Please list the name of the representative that was spoken with:

Did the organization provide assistance?

YesNoRequest Pending

Notes about assistance requested / provided by the organization:

Primary Applicant (Must be an ADULT)

Household (Last) Name:

Household Size (Adults and Children):

First Name:

Last Name:

Contact Information

Applicant's Primary Phone

Applicant's Email Address:

Language

Preferred language spoken:

EnglishSpanishOther

Other Language:

Please indicate translation needs. Can the referring organization or a household member translate for the applicant? Does HFA need to translate?

EmailNotification

Assistance Request

Note: HFA cannot cover any medical expenses including medical bills, dental bills, insurance premiums, co-payments, deductibles, medications, factor, etc. We do not cover subscription services, gym memberships, or legal bills.

I understand the limitations and attest that the expressed use of the funds do not violate the limitations of the Helping Hands funds.

How would you categorize the Applicant's need?

In your opinion, what is the urgency of this request?

Please briefly explain the Applicant's need for requested assistance:

Upon submission, the applicant will receive an email with a link to continue and submit this application online. You will be copied on the email, in the event you need to assist the applicant to submit.