Program for Reimbursing Expenses of Living Organ Donors – PRELOD

Application ChecklistTo ensure that your PRELOD application is processed as quickly as possible, please ensure that all the correct forms and supporting documentation are submitted. To be considered for reimbursement, all forms must be received no later than 12 months after donor surgery or your last assessment visit at the Transplant Hospital. Please refer to the Application Checklist (below) prior to completing your application package.

FORM WHEN TO APPLY / COMPLETEREQUIRED SUPPORTING

DOCUMENTATIONOTHER

□ Application Form, Section A

Section A may be submitted as soon as the assessment process has begun in order for a claimant file to be open with PRELOD..

Submission of Section A opens a file with PRELOD however the application will not be processed until Sections B and C are submitted.

□ Application Form, Section B

Submit Section B after actual expenses have been incurred for travel, parking/public transit, accommodations, meals and/or meal allowance.

Provide original* receipts for all incurred costs.

If claiming mileage, please complete Section C of the Application Form.

* If you are also applying to the Northern Health Travel Grant (NHTG), please note that duplicate receipts may be accepted if the original was submitted to NHTG.

If you are applying for Meal Allowance, you are not eligible to claim for Accommodations and Meals for the same dates.

If you are claiming expenses for travel from outside of Ontario, please ensure that the Support to Travel Letter is completed prior to travelling to Ontario.

□ Application Form, Section C

Complete only if claiming mileage. Submit Section C with Section B of the Application Form.

□ Income and Benefit Verification Form

You should complete and submit the Income and Benefit Verification Form as soon as donor surgery is scheduled.

Proof of amounts specified in Sections B, E and J of the Form are required. Supporting documentation may include: Pay Statement, Benefit Statement and an

Please utilize the reference tool B4: Income Loss Form Guidelines when completing section B4 of the Form.

Employment Insurance Statement. For self-employed applicants, please contact the

The loss of income subsidy is only available to applicants who are Canadian residents

Trillium Gift of Life Network157 Adelaide Street West, Box 606

Toronto, Ontario M5H 4E7Ph: 416-619-2342 or 1-888-977-3563 (1-888-9PRELOD)

Email: PRELOD@giftoflife.on.ca

PRELOD Administrator and include the previous 2 years CRA income tax assessments.

Applicants may be requested to provide supporting documentation if further information is required

□ Support to Travel Letter

Have the Travel Support Letter completed if you are travelling from outside of Ontario (including other provinces within Canada and International) for assessment or surgery to become a Living Organ Donor prior to travelling to Ontario. Submit the Letter with Section B of the Application Form.

□ Loss of Income Certificate

Complete the Certificate with your Transplant Physician/Coordinator as soon as donor surgery is scheduled.

Submit with the Income and Benefit Verification Form.

Only Canadian applicants are eligible for the Loss of Income Subsidy.

□ Consent to Sharing of Personal Information for Northern Ontario Residents Only

If you are applying to the NHTG and PRELOD, please submit the Consent with Section A of the Application Form to minimize delays in processing your application.

We are unable to proceed with processing applicants who have applied to both NHTG and PRELOD, unless a Consent Form has been completed

For Northern Ontario Residents Only.

Please apply to the NHTG prior to PRELOD.