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Family Health Insurance Assistance Program

FHIAP Children's Postcard Response Form
Information About the Postcard You Received
FHIAP has openings for children!
 
If you recently received a postcard from us and have uninsured children in your family, we may be able to help pay for insurance for them. If you want an application, please fill out the form below and press the “Submit” button.
 
If your children are already insured, please let us know that on the form below. You can also use this form to update your information.
 
If you have not received a postcard from us and you are not yet on our reservation list, please call 1-888-564-9669 or go to www.fhiap.oregon.gov to get on the list.

Request A FHIAP Application For Your Child(ren)
FHIAP reservation number:
Type in your nine (9) digit reservation number below. This number can be found on the yellow postcard that you received in the mail. It is above your name on the front of the postcard or on other documents that you received from FHIAP.
Reservation number:
Contact information:
First name:
Middle initial:
Last name:
Day phone:
E-mail address:
Do you want a FHIAP application for your child(ren)? Yes
No. If no, why:
Mailing information:
Address change? Yes 
Mailing address:

City:

State:

ZIP:

 
Press “submit,” below and an application will be sent for your child(ren) within 2-3 weeks.