Ricky Ray Hemophilia Relief Fund
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To be eligible for payment, petition forms had to be postmarked between July 31, 2000 and November 13, 2001. No petitions postmarked after November 13, 2001 will be accepted.

Individuals who submitted petitions during the filing period may need the following forms:

• Confidential Physician or Nurse Practitioner Affidavit (Adobe Acrobat)
• Payment Form for electronic funds transfer and instructions (Adobe Acrobat)

Contact:
Ricky Ray Program Office
HRSA Bureau of Health Professions
Room 4-81
5600 Fishers Lane
Rockville, MD 20857
toll-free telephone: 1-888-496-0338
e-mail: RRay_program@hrsa.gov