Financial Assistance Application - California

Download and Mail

Please download the paper form and mail it, and the required documents, to:

PH&S Regional Business Office
P.O. Box 4227
Portland, OR 97208-3395

If you have any questions, please call us at:

855-229-6466
Monday-Friday 8 a.m.-5:30 p.m. PT

We will respond to your request via email within 14 business days of receiving it along with all required documents.