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Home > Patients & Visitors > Financial Matters > Financial Counseling > Financial Assistance Packet
Financial Assistance Packet

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Listed below is all of the information you will need to apply for financial assistance.  We recommend that you begin with the Application Packet Description, which provides a brief explanation of all the forms and provides examples of how you should use the forms.

Red arrow Access the Application Packet Description

The primary application form is the HPA/UMA/CMH Financial Assistance Application.  You must complete this form and then complete the other forms as required, based on your financial situation.

Red arrow Access the HPA/UMA/CMH Financial Assistance Application

You will be required to send supporting documents in addition to the forms listed below.  The Approved Documents List gives examples of those supporting documents.

Red arrow Access the Approved Documents List

When you are ready to submit the Financial Assistance Packet, print a copy of the required forms below and complete them.  Send the required forms, the HPA/UMA/CMH Financial Assistance Application, and copies of your supporting documents to:

MUSC/UMA/CMH
One Poston Road, Suite 350
Charleston, SC  29407

Red arrow Income Declaration Statement
Red arrow Support Provider Assistance Statement
Red arrow Alimony/Child Support Statement
Red arrow Employee Verification Statement
Red arrow Employment Status Statement
Red arrow Dependent Statement

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