Form
Age:
25 and under
25-34
35-44
45-54
55-64
65+
Residence Status:
Canadian citizen
Indigenous person (registered under the federal Indian Act)
Permanent resident (formerly called a “landed immigrant”)
Applying for permanent residence
Temporary Worker
Work permit, working in Ontario for at least 6 months OR under the federal live-in caregiver program OR under federal seasonal agricultural worker program
Refugee claimant
Convention refugee or other protected person
Temporary Resident Permit
In Canada with emergency authorization for humanitarian reasons
I have Indian Status.
Yes
No
I've applied for permanent residence, I have been Approved in Principle.
Yes
No
Who are you applying for?
Myself
Myself and my spouse
Myself, my spouse and dependent(s)
Myself and my dependent(s)
On behalf of someone else
I live with:
Alone
My married partner
My married partner and our kid(s)
My Common Law spouse
My common Law spouse and our kid(s)
My partner (not common law)
Two people living together with a shared dependent
With a roommate(s) but we are financially independent of each other
Where I live:
An apartment/condo
A single family house
A long-term care home
A special care home
A community Home for Opportunity
Housing insecure with a mailing address
Housing insecure without a mailing address
Number of adults in my household.
Number of dependents in my household.
Combined household income, after deducting tax, from the last tax year (before the most recent August 1st) for all household family members 18 years of age and older. [Line 23600 on your last Notice of Assessment from the Canada Revenue Agency]
$35,000 or less
$45,000
$47,000
$50,000
$52,500
Between $52,500 and $100,000
Between $100,001 and $150,000
Over $150,000
I receive either or both of the following additional support. (If neither, skip this question):
Professional home and community care services
Benefits from Ontario Works or Ontario Disability Support Program
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Do you currently live in Ontario?
Yes
No
What are the first 3 digits of your postal codes?
I, and everyone in my household, have a valid Ontario Health Card Number (OHIP).
Yes
Yes, but I don’t have my card or number
No
I have my Social Insurance Number (SIN).
Yes
No
I'm eligible to work in Canada.
Yes
No
I'm currently enrolled in another Ontario Drug Benefit program.
Yes
No
I have private insurance that:
Covers my prescriptions 100%
Partially covers my prescriptions
I have no private insurance
Total amount of household income after taxes (net income) per year:
Total household cost of prescriptions per month. TDP will only work on eligible prescription drugs. Check and see if your prescriptions are covered by TDP before filling out this part:
I currently have my taxes filed from last year.
Yes
No
I have documents to prove my income from last year (T4, Record of employment, etc).
Yes
No
I'm new to Ontario.
Yes
No
I've physically been in Ontario for at least 153 days of the first 183 days after you moved to Ontario.
Yes
No
I will or plan to travel outside of Ontario more than 7 months (212 days) throughout the year.
Yes
No
Ontario is my primary residence.
Yes
No
Are you any one of the following?
I’m In Ontario on a valid work permit and are working full-time in Ontario, for an Ontario employer, for at least 6 months (if you meet this requirement, your spouse and dependents may also qualify for OHIP)
I have a work permit that has expired but I hold “maintained status”
I’m in Ontario on a valid work permit under the federal Live-in Caregiver Program
I’m In Ontario on a valid work permit under the federal Seasonal Agricultural Worker Program
I’m a convention refugee or other protected person (as defined by Immigration and Refugee Board of Canada)
I have aTemporary Resident Permit (only certain case types, for example 86 through 95)
I’m a clergy member who can legally stay in Canada and will be ministering full time in Ontario for at least 6 months (if you meet this requirement, your spouse and dependents may also qualify for OHIP)
None of the above
Email
example@example.com
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I have a valid Ontario Health Card Number (OHIP).
Yes
Yes, but I don’t have my card or number
No
25 years old and under:
25 and under
25-34
35-44
45-54
55-64
65+
65 years old and older:
25 and under
25-34
35-44
45-54
55-64
65+
Age and Marital Status:
25 and under
25-34
35-44
45-54
55-64
65+
Do you have Indian Status?
Yes
No
I have a valid Ontario Health Card Number (OHIP).
Yes
Yes, but I don’t have my card or number
No
I have my Social Insurance Number (SIN).
Yes
No
I'm currently enrolled in another Ontario Drug Benefit program.
Yes
No
I have private insurance that:
Covers my prescriptions 100%
Partially covers my prescriptions
I have no private insurance
I currently have my taxes filed from last year.
Yes
No
I have documents to prove my income from last year (T4, Record of employment, etc).
Yes
No
Combined household income, after deducting tax, from the last tax year (before the most recent August 1st) for all household family members 18 years of age and older. [Line 23600 on your last Notice of Assessment from the Canada Revenue Agency]
$35,000 or less
$45,000
$47,000
$50,000
$52,500
Between $52,500 and $100,000
Between $100,001 and $150,000
Over $150,000
Total number of members in the household.
Where I live:
An apartment/condo
A single family house
A long-term care home
A special care home
A community Home for Opportunity
Housing insecure with a mailing address
Housing insecure without a mailing address
Have you physically been in Ontario for at least 153 days of the first 183 days after you moved to Ontario?
Yes
No
Percentage of income spent on prescriptions
I'm eligible to work in Canada.
Yes
No
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