Helping Hands Referral Form

HFA鈥檚 Helping Hands Emergency Assistance is designed to establish a rapid, non-invasive source of relief for emergency situations or urgent needs to persons who are affected by diagnosed bleeding disorders. Each year, Helping Hands aids hundreds of families in crisis situations with emergency/urgent funding for basic living expenses such as housing, transportation, and utility bills. Helping Hands cannot cover any medical expenses including medical bills, dental bills, health insurance premiums, co-payments, deductibles, medications, factor, testing etc. Please visit HFA鈥檚 Navigating Patient Assistance Programs chart to find other financial resources.*

Eligibility Requirements:

  • Applicant is an individual with a diagnosed 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 have recently experienced hardship directly resulting from or directly impacting the bleeding disorder.
  • The request is related to housing, utilities, transportation, or a similar basic living expense.
  • We do not accept self-referrals for Emergency Assistance. The referral must be submitted聽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

Steps to Apply:

  1. The applicant cannot submit their own referral for Emergency Assistance. Referrals must be submitted by an eligible referrer via this website.** The referrer will need to know the following information about the applicant in order to submit a complete referral form.
    • Applicant鈥檚 contact information
    • Household members鈥 names and relationships
    • Bleeding disorder diagnosis
    • Healthcare location
    • Description of need. Please include聽bill due date if urgent
  2. Referral form is received by the Helping Hands staff and applicant is contacted within five business days to complete a phone interview. During the interview, the applicant will be 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. Applications are submitted to the committee anonymously.聽The applicant鈥檚 identity is not shared with the committee members.
  4. If approved, the applicant is required to submit a written statement of need and copy of the bill/lease prior to payment.
  5. The process is generally completed within two weeks.

*Please contact HFA at 202-675-6984 or 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.


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