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)
P.O. Box 715
Trenton, NJ 08625-0715
www.nj.gov/humanservices
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. This
application is ONLY for people who are applying for PAAD or Senior Gold benefits for the first
time. If you are married, and you and your spouse wish to apply for benefits, each of you must
complete a separate application.
PAAD and Senior Gold are state-funded prescription programs that help eligible New Jersey residents
with the cost of prescribed medication (including insulin, insulin needles, and needles for injectable
medicines used for the treatment of multiple sclerosis).
While you are applying for assistance with your prescription costs by filling out this application, you may
be eligible for several other valuable benefits if you are eligible for PAAD. For example, if eligible for
PAAD, you may be eligible for benefits through the Lifeline utility assistance and Hearing Aid Assistance
to the Aged and Disabled programs.
Once you are on the PAAD program, you may qualify for a property tax freeze, reduced motor vehicle
fees, and Communications Lifeline.
Further, by filling out this application, you will be screened for benefits provided by the Universal Service
Fund (USF) and the Low-Income Home Energy Assistance Program (LIHEAP) – two more programs that
help pay for utility costs. In addition, you will be screened for “Extra Help with Medicare Prescription Drug
Plan Costs” – a program that helps pay Medicare Part D costs; the Specified Low-Income Medicare
Beneficiary (SLMB) or SLMB Qualified Individual programs – two programs that pay Medicare Part B
premiums; and the New Jersey Supplemental Nutrition Assistance Program (NJ SNAP) – also known as
Food Stamps, this program provides supplemental nutrition assistance to help people who meet certain
income criteria buy groceries.
If it appears that you may be eligible for USF, LIHEAP, the “Extra Help,” SLMB/SLMB QI-1, and/or NJ
SNAP, PAAD will forward your information to these programs for eligibility consideration.
Turn this page over for a comparison of PAAD and Senior Gold.
For More Information,
Visit www.njpaad.gov or www.njsrgold.gov
Or, Call 1-800-792-9745