Important Forms

Medicare Part D Plan Finder/Data Form - Current Medicare Part D beneficiaries and new enrollees are encouraged to a review of their medications and Part D Drug Plan each year.  Use this form before scheduling your meeting with a SHINE (Serving Health Insurance Needs of Everyone) Counselor

Emergency Assistance Request Form- Emergency Help - Imagine being trapped in your home with no electricity, telephone service or heat.  What would  you do without power during a hurricane or blizzard or in the days that follow?  Fill out this form to tell us what your special needs are.  Return it to the COA and it will be shared with Emergency Responders in the event of an emergency.