Nursing Home Application Nursing Home Application

The TV Converter Box Coupon Program has reached its funding ceiling. However, coupon requests from eligible households will be filled as funds from expiring coupons become available. If you would like to apply for a coupon today and are eligible, you will be placed on a waiting list and will receive coupons on a first-come-first-served basis as funds from expiring coupons become available.

Residents of licensed nursing homes, intermediate care facilities, and assisted living facilities are eligible to request coupons from the TV Converter Box Coupon Program.  Residents must use the special Nursing Home application form.

If you are a resident of a licensed nursing home, intermediate care facility or assisted living facility, you may apply for one coupon using the application on this page. A family member or a representative from the licensed facility may apply for one coupon for a nursing home resident, but the coupon will be mailed directly to the nursing home resident.

To address the possibility of waste, fraud and abuse, the Coupon Program will be vigilant and will deny applications that appear to be fraudulent. The address of each applicant will be checked against a third-party database to assist in validating eligibility.
 

Have more questions? Visit our FAQs for more information!

Apply for a Coupon
Check your Application Status
Recent Updates
Download Application