An applicant for a cancer treatment grant shall submit a completed application to the CCPC. Cancer treatment grants are open and continuous throughout the year to the extent that funding is available. An applicant seeking a cancer treatment grant to pay for cancer treatment costs shall include in the Department's application packet: A completed cancer treatment grant application for each individual for whom grant funds are being requested, including the: Name; Phone number; Mailing address; County; and Signature of the: Individual diagnosed with cancer if the individual is an adult; or Parent or guardian if the individual diagnosed with cancer is younger than 18 years old; A letter written by the individual’s physician on the physician’s letterhead: Confirming: That the individual has been diagnosed with or treated for cancer or the individual has a finding suggestive of cancer and needs to obtain a cancer diagnosis; and The dates of diagnosis or treatment; and Containing the physician's: Full name; Address; Specialty; and Medical license number; Proof of current Maryland residency for at least 6 months before the application date for each individual for whom grant funds are being requested in one of the following forms: Maryland driver’s license or State identification card; Lease or rental agreement; Property tax bill; Motor vehicle registration; Pay check or stub with name and home address; Utility bill; Voter registration card; or W-2 statement issued not more than 12 months ago; Proof of annual family income for each individual for whom grant funds are being requested, including a copy of at least one of the following: Most recent: Income tax return; or W-2 form; Pay stubs for two: Consecutive pays; or Pays in the same month; Social security entitlement letter; or Notarized letter from the individual stating that the individual is not working and does not have any income; Documentation of the eligibility of the individual for grant funds, including: The family size of the individual for whom the applicant is applying; and The family’s annual household income; Certification that the applicant will: Keep financial records, as described in Regulation .16B of this chapter; Send demographic and fiscal information on each individual covered to the CCPC at the end of the grant period; and Act as the authorized representative of the individual. Attestation that grant funds will not be used to supplant any existing funding for this cancer treatment activity; and If the applicant currently receives funding for a similar cancer treatment activity, a list of the funding: Source; Amount; and Period for the activity. An applicant seeking a cancer treatment grant to pay for deductibles and patient contribution costs through their health insurance policy under Regulation .08E(2) of this chapter shall include in the Department’s application packet: A completed and signed Maryland Cancer Fund — Cancer Treatment Grant application that; Certifies that the applicant shall pay: The deductible and patient contribution amount; and Costs for services not covered under the individual’s health insurance policy for a time period not to exceed 1 year; and Includes a treatment plan for a total request not to exceed a specified amount, as determined by the Department, per individual per year, including the: Deductible and patient contribution amount; and Costs for services not covered under the individual’s health insurance policy. Documentation of the individual’s health insurance policy. An applicant seeking a cancer treatment grant to pay directly for cancer treatment costs under Regulation .08E(3) of this chapter shall include in the Department’s application packet: A completed Maryland Cancer Fund — Cancer Treatment Grant application; and A signed document that certifies that the applicant shall pay directly for cancer treatment costs for the individual for a time period not to exceed 1 year; and certifies that the applicant shall: Reimburse the provider in an amount not greater than the Medical Assistance rate for the medical procedure or the HSCRC-regulated rate for the medical procedure performed, if the medical procedure is performed in a HSCRC-regulated facility; or Accept the Medical Assistance rate as payment in full for the cancer treatment procedures performed, if the applicant is a medical provider; and Includes a treatment plan for a total request not to exceed $20,000 per individual, including: The planned cancer treatment procedures; and The Medical Assistance or HSCRC-regulated rate for each procedure.