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| • Use this application to apply for anyone in your family.\u003Cbr>• Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage.\u003Cbr>• If you’re single, you may be able to use a short form. [Visit](Visit njfamilycare.org)[ ](Visit njfamilycare.org)[njfamilycare.org](Visit njfamilycare.org).\u003Cbr>• Families that include immigrants can apply. You can apply for your\u003Cbr>\u003Cbr>immigration status or chances of becoming a permanent resident or citizen.\u003Cbr>• d to complete Appendix C. |\n| --- | --- | --- |\n| | Apply faster online | Apply faster online [at](at njfamilycare.org)[ ](at njfamilycare.org)[njfamilycare.org](at njfamilycare.org). |\n| | What you may need to apply | • Social Security Numbers (or document numbers for any legal immigrants who need insurance)\u003Cbr>• Employer and income information for everyone in your family (for example, from paystubs, W-2 forms, or wage and tax statements)\u003Cbr>• Policy numbers for any current health insurance\u003Cbr>• Information about any job-related health insurance available to your family |\n| | Why do we ask for this information? | We ask about income and other information to let you know what coverage you qualify for and if you can get any help paying for it. We’ll keep all the information you provide private and secure, as required by law. To view the Privacy Act Statement, go to [njfamilycare.org](njfamilycare.org). |\n| | What happens next? | Send your complete, signed application to the address on page 7.\u003Cbr>If you don’t have all the information we ask for, sign and submit your application anyway. We’ll follow-up with you within 1–2 weeks. You’ll get instructions on the next steps to complete your health coverage. If you don’t hear from us, visit [njfamilycare.org](njfamilycare.org) or call 1-800-701-0710. Filling out this application doesn’t mean you have to buy health coverage. |\n| | Get help with this application | • Online: [njfamilycare.org](njfamilycare.org)\u003Cbr>• Phone: Call our Help Center at 1-800-701-0710.\u003Cbr>• In person: There may be counselors in your area who can help. Visit our website or call 1-800-701-0710 for more information.\u003Cbr>• En Español: Llame a nuestro centro de ayuda gratis al\u003Cbr>1-800-701-0710. |\n\nNJ FC-APP-E-0724  \nSTEP 1  \nTell us about yourself.  \n\n| 1. First name, Middle name, Last name, & Suffix |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| 2. Home address (Leave blank if you don’t have one.) |  |  |  |  |  |  | 3. Apartment or suite number |\n| 4. City |  | 5. State |  | 6. ZIP code |  | 7. County |  |\n| 8. Current mailing address (if different from home address) |  |  |  |  |  |  | 9. Apartment or suite number |\n| 10. City |  | 11. State |  | 12. ZIP code |  | 13. County |  |\n| 14. Home phone number\u003Cbr>( ) – | 15. Cell phone num ( ) |  | \u003Cbr>ber\u003Cbr>– |  |  Check here if you do not grant us permission to text you. (Your phone plan\u003Cbr>might charge you for text messages.) |  |  |\n| 16. Do you want to get information about this application by email?  Yes  No\u003Cbr>Email address:   |  |  |  |  |  |  |  |\n| 17. What language do you prefer to use? What language should we use for your NJ FamilyCare letters?  English  Spanish |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |\n\n(We need one adult in the family to be the contact person for your application.)   \nSTEP 2  \nTell us about your family.  \nFamily Planning (Plan First Program)  \nIf any person on this application is not eligible for NJ FamilyCare, would you like them to be evaluated for family planning services (Plan First Program)?  \nYes  Check here for all applicants ","cbCaihGnS91T6OPX","https://ap.wps.com/l/cbCaihGnS91T6OPX","pdf",1528968,"English","# Things to Know\n## Who can use this application?\n## Apply faster online\n## What you may need to apply\n## Why do we ask for this information?\n## What happens next?\n## Get help with this application\n# STEP 1\n## Tell us about yourself\n# STEP 2\n## Tell us about your family\n### Family Planning (Plan First Program)","[{\"question\":\"谁可以使用这份NJ FamilyCare申请？\",\"answer\":\"任何需要为家庭成员申请的人都可以使用该申请。即使你或你的孩子已经有健康保障，也可能符合更低成本或免费的覆盖选项，并且包含移民家庭同样可以申请。\"},{\"question\":\"提交申请时通常需要哪些信息？\",\"answer\":\"通常需要社会保障号（或对需要保险的合法移民提供的证件号码）、家庭成员的雇主与收入信息（例如工资单、W-2表或工资与税务声明）、任何现有健康保险的保单号，以及与工作相关的可用健康保险信息。\"},{\"question\":\"申请提交后接下来会发生什么？\",\"answer\":\"将完整且签署后的申请寄到第7页的地址。即使没有提供全部被要求的信息，也可以签字提交；机构将在1–2周内跟进，并提供完成健康覆盖所需的下一步说明。\"}]","NJ FamilyCare Health Coverage Application - STEP 1 and STEP 2 | PDF",1789833022,6]