Location: Forms Home > Quick Search > Quick Search Results > Form Details

Form Details

Form Format
Click here if you are having trouble opening your PDF form

FormatForm Link AddressFunctionalitySize
Adobe PDF Adobe PDF document  Annual Deductible Re-Assessment Request – For Program Year 2020/21 Based on 2020 or 2021 IncomeThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill & Print1388.0 kb

Form Classification
Classification / Identification:
 Form Number:014-4931-87EEdition date: 2020/08 
 Title:Annual Deductible Re-Assessment Request
 Branch/ABC:Drug Programs Delivery Branch  
 Program:Ontario Drug Benefit  
 Purpose of Form:MOHLTC form for Trillium Drug Program (TDP) Households to request a re-assessment of their TDP Household's deductible.  

You must download Adobe Acrobat Reader (version 10.0 or above) to view/print PDF forms.
Click here for further instructions.

If PDF forms do not open in the latest versions of Firefox and Chrome, click here for the solution.

Protecting Your Information: If you are using this online service on a shared computer in a public area (i.e. public library), it is important to ensure that you do not leave the computer unattended while accessing the service. Before leaving the computer, it is also important that you fully exit the application, clear your browser's cache (This link opens in a new window) and close down your browser. This will ensure that no one else can access any personal information you may have entered.