Consumer Assistance Program (CAP)

BACKGROUND

SDO provides financial assistance to families with bleeding disorders at the Executive Board’s discretion if funds are available. The CAP fund is used to assist families and/or individuals experiencing financial strain caused by the bleeding disorder. The expectation is that they have sought out alternative sources of funding. Due to limited funds it is necessary to have a policy in place. This policy will be reviewed annually by the Board of Directors.

POLICY

Eligibility: Eligible families and/or individuals are those living in New Mexico or in transition to New Mexico. (Definition of “families” is the family/guardian/unpaid caregiver living with the person with the bleeding disorder including hemophilia, Factor Deficiency, VWD, and platelet disorders). If a board member requests CAP they must excuse themselves from the decision making.

Application: All persons requesting assistance will fill out an application either online or hard copy and submit along with supporting documentation. Supporting documents may include copies of bills, quotes for services, etc. The completed CAP form along with attachments, must be submitted to the Executive Director and/or Executive Board. The expectation is that the application is submitted at least ten days prior to when the funds are required. Emergency situations will be handled on a case-by-case basis.

Process

The Executive Director will screen the requests (unless another individual has been designated)
The Executive Director or designee has the authority to approve requests up to $500.00 and must report any approval to the Executive Board.
The Executive Board will vote on all requests above $500.00.
The billing source (third party) will be paid directly, if possible.
Individuals approved for a direct payment over $600.00 are legally required to complete a W9 prior to receipt of funds. Payments over $600.00 in a calendar year are considered individual income and have tax implications. It is the individual’s responsibility to report receipt of any direct payment(s) to the appropriate agency(s).
Families may request CAP up to three (3) times in a calendar year, not to exceed a total of $750.00 during the calendar year. Any requests above the policy limits must be submitted to the Executive Board for consideration.
All CAP requests will be approved/denied within 2 weeks of receipt of complete application.

Please fill out the form below or download the form here: Cap App Blank.pdf

Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Employment Status*
Phone*
This is a*
Person(s) living in the home*
Person(s) financially responsible*
Type of bleeding disorder*
Please give a description of your funding request*
Sangre de Oro is interested in more volunteers. Would you like to be contacted for volunteer opportunities?*
- Yes
- No
Assistance amount requested*
It is SDO's policy, whenever possible, to dispense funds directly to businesses or individuals where funds are due.
Make check payable to*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Please provide any receipts or documents pertaining to your request
Drop files here or

Max. file size: 512 MB.
These may state the amount requested or show your needs
What other resources have been used without success for this request of assistance?*
eg: NM Medicaid, UNM-H Vouchers
Signature*
Confidentiality Statement

SDO, Inc./HFNM helps all people with bleeding disorders. We are committed to our mission without regard to disability, gender, religion, race, sexual orientation or age. It is SDO's policy that all requests are evaluated. Funding Assistance is not guaranteed and is dependent upon availability of funds and financial need of the applicant. All records will be kept confidential.
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Confidentiality Statement

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