Transcription of AP-2, Universal Application for PAAD, Senior Gold and ...
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AP-2, Universal Application for PAAD, Senior Gold and ...
AP-2 (Instructions) JAN 16 New Jersey Department of Human Services Pharmaceutical Assistance to the Aged and Disabled (PAAD), Lifeline and Special Benefit Programs Senior Gold Prescription discount Program ( Senior Gold) Box 715 Trenton, NJ 08625-0715 Universal Application FOR PAAD, Senior GOLD AND OTHER SPECIAL BENEFIT PROGRAMS By filling out the attached Application , you may be eligible for benefits provided by the Pharmaceutical Assistance to the Aged and Disabled (PAAD) or the Senior Gold Prescription discount programs.
Special Benefit Programs/Senior Gold Prescription Discount Program (Senior Gold) PO Box 637, Trenton, NJ 08646-0637 Toll Free Hotline 1-800-792-9745 I am applying for: Prescription Assistance Lifeline Utility Benefit PLEASE PRINT YOUR NAME ON THE TOP OF EACH PAGE. 1. Enter your name, date of birth and sex. List your Social Security number.
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