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DS2444A Rev. 2019-07 Remove this page and keep it for your Application - General InformationSubmit the AISH Application and supporting documents by:1. Complete Part A Applicant Information, and use the Application Checklist on the next page to gather copies of the documents you must provide. Part B Medical Report to your doctor to complete. You will have to pay a fee to the doctor to complete the report. If you need help paying the fee, contact the Alberta Supports Contact Centre for options. The doctor can send the Medical Report, with supporting documents directly to AISH and give you a copy, or the doctor can send the report and documents to you, to add to Part A of your mailing them to PO Box 17000 Station Main, Edmonton, AB, T5J 4B3; or taking them to your nearest AISH office / Alberta Supports Centre; or submitting them online at them to 587-469-3006 (Edmonton Area) or 1-877-969-3006; or IntroductionThe Assured Income for the Severely Handicapped (AISH) program provides financial and health benefits to eligible Albertans with severe and permanent disabilities.

1. Complete Part A Applicant Information, and use the Application Checklist on the next page to gather copies of the documents you must provide. 2. Take Part B Medical Report to your doctor to complete. You will have to pay a fee to the doctor to complete the report.

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cfr.forms.gov.ab.ca

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