APPLICATION FOR RENT/UTILITIES/CREMATION ASSISTANCE
This application can be filled out on-line. We encourage you to type the Non-Medical application on-line and then print the application.
NOTICE: Once you begin filling out an application, you cannot leave that page or you will lose any information you’ve typed into the application. You CANNOT SAVE this information or the application on your computer. Once you complete the application and proof it for accuracy, print it and bring it with you to the interview.
- Fill out the application completely
- Proof it for accuracy
- Print and sign it
- Contact Ada County Indigent Services and request an interview (287-7960)
- Bring the completed application with you to the interview (no interviews will be granted without a completed application)
You CANNOT SUBMIT YOUR APPLICATION ON-LINE! You must print the completed application, sign it and bring it with you. Ada County Indigent Services is located at 252 E. Front St., Suite 199, Boise, Idaho 83702.
INTERVIEWS are conducted only on Tuesday, Wednesday and Thursday beginning at 8:30 a.m. The last interview will begin at 3:00 p.m. on those days. Interview times are awarded on a first-come-first-served basis. Only 8 interviews each day will be conducted.
If you fill out the application in your own handwriting, please use black or blue ink. Applications filled out with pencil or ink color other than black or blue will not be accepted.
USE THIS FORM ONLY FOR ASSISTANCE WITH BILLS FOR:
- Rent
- Heating oil
- Natural gas
- Electric Power
- Water Bills
- Indigent Deceased
Please Note: Files formatted in Portable Document Format (PDF) require the Adobe Acrobat Reader to access.
You can download the free reader directly from Adobe. Acrobat and the Acrobat logo are trademarks of Adobe Systems Incorporated.
Click here to access the application form:
Application For Rent/Utilities/Cremation Assistance
MEDICAL ASSISTANCE
USE THIS FORM ONLY FOR ASSISTANCE WITH:
- Medical Bills
- Medication Costs
- Cobra and PCIP Insurance Premiums
Please note that the medical application does require a lot of information. This is required by state law as all applications received by Indigent Services are shared with the Department of Health and Welfare to determine if the applicant is eligible for Medicaid payment of the medical services. Thank you for your patience and please be sure to complete the entire application.
Please Note: Files formatted in Portable Document Format (PDF) require the Adobe Acrobat Reader to access.
You can download the free reader directly from Adobe. Acrobat and the Acrobat logo are trademarks of Adobe Systems Incorporated.
Application for Assistance With Payment of Medical Bills