This poster template was produced to help licensees under Ontario’s Payday Loans Act, 2008 comply with requirements pertaining to posters for payday loan agreements under that act. This is not an official form required by the Ministry of Public and Business Service Delivery; no data in this template is required to be returned to the ministry.

To be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who do not have a Notice of Assessment.

Application may only be completed for recipients of ODSP. The following approved health care professionals licensed to practice in Ontario can complete the application: • Physicians, Nurse Practitioners, Registered Nurses, Occupational Therapists, Physiotherapists, Physician Assistants, and Psychologists* *Psychologists can only complete the Medical Transportation section of the form. The application may only be completed for medical supplies, items, and devices listed in the MSN Schedule of Benefits (https://www.ontario.ca/page/ontario-disability-support-program-health-and-disability-benefits) and items must not be otherwise reimbursed or subject to reimbursement from any other source.

This application form is for family members (“applicant”) who have been granted standing at a coroner’s inquest where the deceased was a victim of crime or involved in a police-related incident. The applicant or their legal representative can complete this form to apply for reimbursement of eligible legal fees and expenses under either the Coroner’s Inquest Legal Fee Reimbursement Program or the Coroner’s Inquest Family Reimbursement Program. Please consult the Coroner’s Inquest Legal Fee Reimbursement Program/Coroner’s Inquest Family Reimbursement Program Guideline for information on program eligibility criteria, eligible expenses, and the reimbursement process.