Allegany County Cancer Services, Inc.

 

"In Allegany County ... For Allegany County"

Application Form and  Requirements

To qualify for a gas card from ACCS the following guidelines must be met:

1,  You must live in Allegany County, New York and prove your residency and identity

2.  You must have a cancer diagnosis that is proven by a signed Physician Verification form.

3.  You cannot have Medicaid - as  Allegany County Medicaid will reimburse travel and ACCS is always the payer of last resort.

4.  Since March of 2011, ACCS can only provide a one time award of a gas card because of the large volume of applicants.

5.  The Application Form provided on this website must be fully completed as required in order for an application to be  considered.

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Application Form
Brochure