ACSDAssistance For Children With Disabilities

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What is ACSD?

• Assistance for Children with Severe Disabilities (ACSD) is a Government Of Ontario program that gives funding to parents to help with extraordinary costs related to your child's severe disability

Ministry of Community and Social Services and the Ministry of

Children & Youth Services

• ACSD is a non-taxable funding program for low and moderate income families

• The amount of ACSD funding that can be received is based on your yearly extraordinary expenses and gross family income

• This funding can help parents afford extra costs related to your child's severe disability. Examples of extra costs are: travel to and from doctors and hospitals, parking at healthcare appointments, special shoes and clothing, parent relief, wheelchair repairs, and financial assistance

How much can you qualify for?

• Families may be entitled to up to ($450.00 per month.

• Every family is different!

What are Extraordinary Costs?

• Transportation to and from doctor and hospital appointments

• Special shoes and clothing • Babysitters for younger siblings during medical

appointments • Relief breaks for parents • Special learning and developmental equipment • Social recreation programs

The ACSD Also Includes…

• A Drug Card (used to pay for your child’s prescribed medication)

• A Dental Card (basic coverage for your child is provided) • Coverage for items related to your child’s vision and

hearing • The parent contribution for an Assistive Device for your

child under the Assistive Devices Program (provided through the Ministry of Health and Long-Term Care)

• The cost of assessment for an assistive device and the cost of batteries and repairs

Please input the parent info here

Your child's information

Other children’s names and ages

“Please see attached”

“See attached”

Print Parents Name Here

Today’sDate

Parent Signs HereWitness Signs Here

This section just states that it is important for you to fill in the forms truthfully and to the best of your ability.

Parent and Child

Names

Check here for new

application

Check here and add IDfor renewal

Type of Doctor &

Intersection

Appointments per Year

$0.18 per km and parking

or TTC fare per trip

Meals at appointment if over lunch hour

Use realistic rate

Total

May be due to:•Sensory issues – zippers, tags•Excessive wear – ripping clothes, wearing down knees of pants• Multiple outfits per day

Examples:•Linen for bed wetting•Towels or bibs for drooling•Altered clothing for medical equipment

Extra loads of laundry due to:•Soiling•Multiple clothing changes per day etc

May be due to:•Dragging feet, toe walking•Sensory issues•Crawling and wearing out toes

May include:•Ensure or Vitamins•G Tube feeds•Gluten free diet

$300

May include:•Special school or preschool•Special daycare

May include:•Educational books and toys•Music, DVDs, video games•Bicycle, sensory toys, etc

May include:•Social skills program at Geneva Centre•After school or Weekend programs•Variety Village Membership etc

May include:• A CHAP worker• Respite programs

May include:•Vitamins•Allergy medication•Tylenol•Stool Softners

May include:•Hearing aid batteries•Special head phones

May include:•Gloves, sterile gauze, tape•Bandages, tensor wraps

May include maintenance to :•Wheelchair•Walker or braces

May include:•Damage to household items including painting walls •Patching up holes in the wall•Laundry detergent or softener•Carpet cleaning

Include overview of family situation

Documentation

• Signed application form • Completed Expense Report • Medical statement or psychological assessment that

clearly confirms the diagnosis of your child's disability • Income verification – Notice of Assessment for previous

tax year• Birth Certificate for child• Verification of applicant and child’s status in Canada• Health Card for child and parent• Void cheque