UNITED STATES • BENEFITS PORTAL

Emergency Assistance Application

Complete all required information below. Failure to provide accurate information may result in delays, denial, recoupment, or other action.

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Applicant Information

Pursuant to subsection 14(b), the undersigned hereby attests that all statements, representations, certifications, and disclosures submitted in connection with this application are complete and accurate to the best of the applicant's knowledge and belief, subject to verification by the administering authority.
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CALMLAYER / THREE TESTS

Same information. Different experience.

CalmLayer doesn't remove important information. It changes the order, language, spacing, and interaction so a stressed person can focus on what matters right now.

01

Government aid form

From paperwork overload to one answer at a time.

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Pursuant to subsection 14(b), the undersigned hereby attests that the information provided herein is true, complete, and accurate, and acknowledges that any material omission or misrepresentation may constitute grounds for denial, suspension, recoupment, or further administrative action.
Calm webStep 1 of 4

Do you live in the county where you are applying for help?

How many people live in your household?

Do you have income coming into your household each month?

You're ready for the next part. Would you like help?

02

Medical discharge instructions

From clinical language to three things you can remember.

Normal webDense instructions

Following discharge, the patient should maintain adequate oral hydration and adhere to the prescribed pharmacological regimen, including administration at the indicated intervals, while avoiding strenuous physical exertion and monitoring for clinically significant exacerbation of symptoms, including but not limited to persistent dyspnea, syncope, uncontrolled pain, fever exceeding 38°C, altered mental status, or evidence of infection. In the event of deterioration, the patient should promptly contact the treating physician or seek emergency evaluation.

Calm web3 things

What to do now

Take your medicine exactly as instructed. Drink water and rest today.

What to avoid

Avoid heavy exercise until your care team says it is safe.

When to get help

Get urgent medical help for severe breathing trouble, fainting, confusion, uncontrolled pain, or a high fever.

03

Emergency information page

When everything feels urgent, give someone one next step.

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⚠ EMERGENCY INFORMATION — READ IMMEDIATELY

IF YOU ARE IN IMMEDIATE DANGER CONTACT EMERGENCY SERVICES. DO NOT DELAY. DO NOT REFRESH THIS PAGE. FOLLOW ALL OFFICIAL INSTRUCTIONS. CHECK LOCAL ALERTS. CHECK WEATHER CONDITIONS. CHECK EVACUATION ZONES. CHECK ROAD CLOSURES.
Emergency AlertsShelter LocationsRoad ClosuresSevere WeatherPower OutagesMedical Facilities
Calm webOne next action
Breathe

First, make sure you are somewhere safe.

The web should adapt to people in crisis — not the other way around.