Helping Hands: Emergency Assistance

Helping Hands Referral Form 

HFA’s Helping Hands Emergency Assistance is designed to establish a rapid, non-invasive source of relief for emergency situations that are directly caused by or directly impacting a bleeding disorder. Emergency Assistance focuses on basic living expenses such as housing, transportation, and utility bills. READ THIS ENTIRE PAGE BEFORE PROCEEDING.*

Eligibility Requirements:

• Applicant is an individual with an eligible bleeding disorder and/or lives in the same home of the person with a diagnosed bleeding disorder.
• The applicant must not have applied within the last 365 days.
• The applicant is currently experiencing or has recently experienced an emergency hardship directly resulting from or directly impacting the bleeding disorder.
• The request is related to rent, mortgage, a utility, car payment, or burial assistance. Requests for other types of assistance may not be eligible.*
• 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

NOTE: Helping Hands cannot cover any legal expenses or medical expenses including medical bills, dental bills, health insurance premiums, co-payments, deductibles, medications, factor, testing etc. We do not provide grocery or gas cards. Please visit HFA’s Patient Assistance Portal to find other financial resources.

Steps to Apply:

1. The applicant cannot submit their own referral for Emergency Assistance. Referrals must be submitted by an eligible referrer** (see list above) via this website:
   • Applicant’s contact information
   • Household members’ names, relationships, birthdates
   • Bleeding disorder diagnosis
   • Healthcare location
   • Category of need: housing, utilities, or transportation.
   • Description of need. Please include bill due date if time-sensitive.
2. Helping Hands staff contact applicant for a phone interview, usually within 10 days. The applicant is asked a standard set of questions about monthly household income, expenses, and the situation causing the current need.
3. The Helping Hands staff member submits the application to the Helping Hands Committee. All funding decisions are made by the committee after carefully reviewing the entire situation of the applicant and determining if assistance from Helping Hands will be able to effectively help the applicant in need. The applicant’s identity is not shared with the committee members.
4. If approved, the applicant is required to provide a copy of the bill/lease. Payment is made directly to the landlord/company. All applicants receive information about additional financial and educational resources.
5. The process is usually completed within three weeks.

Helping Hands Referral Form 

*Please contact HFA at 202-675-6984 or helpinghands@hemophiliafed.org with any questions.
**A referral indicates permission to contact both the applicant and the referrer. We will be in touch with the referrer or a local professional about any safety issues raised in our phone interview.