ALI YAVAR JUNG NATIONAL INSTITUTE OF SPEECH AND HEARING DISABILITIES (DIVYANGJAN), MUMBAI ~ 400 050 ADIP Cx [2022 feser Date: 23.02.2022 NOTICE Sub: Invitation of applications for availing financial assistance for provision of Cl accessories or service charges to ADIP Cl beneficiaries under SARRAM Ali Yavar Jung National Institute of Speech and Hearing Disabilities (0), Mumbai has introduced the scheme of financial assistance for provision of Cl accessories or service charges to ADIP cochlear implant (Cl) beneficiaries under SARRAM. ADIP Cl beneficiaries can apply for financial assistance from 23% February 2022 till 2"! March 2022. The details of the scheme and application form are appended (Appendix-l). The applications are accordingly invited from interested and eligible Cl beneficiaries. The last date for receiving the dully filled applications via email is 2 March 2022.on ayinishdadippor@amail.com. For any queries please contact on 09860938551 \ i \; CU > Pleane Put TH (Or. Arun Banik) > pe ee webct re, DIRECTOR \ Feo * 13 ]2) 2922 f 1 OC )2)r02Appendix: 1 ALI YAVAR JUNG NATIONAL INSTITUTE OF SPEECH AND HEARING DISABILITIES (DIVYANGJAN) MUMBAI - 400 050 Financial assistance for provision of Cl accessories or service charges to ADIP cochlear implant (Cl) beneficiaries under SARRAMFinancial assistance to ADIP cochlear implant (Cl) beneficiaries under donation fund received from SARRAM The aim is utilization of interest accrued from SARRAM funds for provision of Cl accessories to ADIP Cl beneficiaries. This program is aimed to provide financial assistance to needy ADIP Cl beneficiaries post implant in order to support them to maintain the device. The scheme would cover only Cl accessories and service charges post warranty. H. Eligibility Conditions: Only those who fulfill the following conditions will be eligible for availing the financial assistance post implant:- Candidate must be ADIP Cl beneficiary The family income should not be more than 1,80,000/- per annum Family with more than one hearing impaired child should be given priority Age below 5 years CI accessories or service charges for which financial assistance is requested should be out of warranty * Quotation from the company for the requisite accessory or service charges should be available Beneficiary who has availed the assistance once will not be considered again until 2 years |. Entitlements under the program: Following amount of financial assistance could be provided to a beneficiary in a duration of one year (Maximum amount 1,50,000/- per annum). ‘S.no__| Description Assistance provided 01 Purchase of accessories 1.¢. coll, cable, | Actual cost or not more magnet, batteries or battery charger “| than 12,000/- 02. Servicing charges i.e. repair of processor ‘Actual cost or not more than 35,000/- J. How and when to apply: Those who complete the eligibility criteria can obtain the application form from AYJNISHD (D), Mumbai ADIP POR section or its website and fill and submit along with following requisite enclosures to the institute either in person or by email {ayjnishdadippor@gmail.com)List of Enclosures: ‘Two Photographs Income certificate issued by MRO Birth Certificate Attested copy of Ration Card Disability Certificate Issued by Chief Medical Officer Quotation of the funds required for the Cl accessories or service charges from the company Cl surgery approval letter from AYJNISHD (D)ALI YAVAR JUNG NATIONAL INSTITUTE OF SPEECH AND HEARING DISABILITIES (DIVYANGJAN), MUMBAI - 400 050 Application form for availing financial assistance for provision of Cl accessories or service charges to ADIP Cl beneficiaries under SARRAM 12. Name of the ADIP Cl beneficiary 13. Agel Sex 14, Parent name, address, contact details and email id: 15. Family income per annum: 16. Date of surgery: 17.Name of the hospital & surgeon: 18. Name of the therapy and mapping center: 19.No. of children with hearing impairment in the family 20. Details of cochlear implant: ‘a. Company name: b. Warranty period: ©. Serial no. of the processor: 241. Mention the Cl processor or accessory problem along with financial assistance required 22. Was the assistance received from this scheme for the beneficiary in past? If yes. mention the date, reason and amount received for the same: All the above mentioned information is true Signature of the parent: Mobile number. Enclose the following: Two Photographs, Income certificate issued by MRO, Birth Certificate, Aitested copy of Ration Card, Disability Certificate Issued by Chief Medical Officer, Cl surgery approval letter from AYJNISHD (0), Quotation of the funds required for the C! accessories or service charges from the company, Troubleshooting report from the ‘mapping audiologist