Penalties for Fraud:
Whoever obtains or attempts to obtain program enrollment for which he or she is not entitled, by means of willful false statements or other fraudulent means, may be considered guilty of a criminal offense and upon conviction may be fined and/or imprisoned.
By Clicking Submit:
I certify that the information for the income of all household members 18 years and older is true and correct to the best of my knowledge and belief. I understand that the information will be verified to the extent possible; and that I may be subject to prosecution for providing false or fraudulent information.
I have read and acknowledge the general eligibility requirements to participate in the Affordability Discount Program. I understand that submitting this application does not automatically enroll me in the Affordability Discount Program, and that the information I have submitted must be verified and approved prior to enrollment.