Form 3033, Hemophilia Assistance Program (HAP) Application

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Effective Date

1/2026

Instructions

Updated: 1/2026

Purpose

People in Texas interested in the Hemophilia Assistance Program fill out Form 3033 to apply for services.

How to Apply 

  • Fill out every part of Form 3033. If filling out by hand, print and use dark ink. For questions, call 800-222-3986.
  • If you are self-employed, send us your most recent tax return showing adjusted gross income.
  • Sign and date Form 3033.
  • Ask your doctor to fill out and send us Form 3032, Hemophilia Assistance Program (HAP) Physical Assessment.
  • Send us Form 3033 and all required documents by:
    • Fax: 512-206-3982, or

    • Mail to:

      Hemophilia Assistance Program
      Eligibility Services
      Mail Code 1938
      P.O. Box 149030
      Austin, TX 78714-9947