Community Service Block Grant (CSBG) Vision Program

206 South Grand, Ste. 202

Okmulgee, OK 74447

Phone: 918-758-2710 Ext. 225

E-mail: Vision Coordinator

IMPORTANT:  IT IS VERY IMPORTANT THAT YOU READ THIS BEFORE COMPLETING AND  SUPPLYING THE NECESSARY DOCUMENTS FOR THE COMMUNITY SERVICE BLOCK GRANT (CSBG) VISION PROGRAM.

v     The application must be complete and signed.  Application will be returned if all documents are not submitted.

v     Applicants must provide copy of Certificate Degree of Indian Blood (CDIB) or Tribal Membership card.

v     Applicants must provide copy of Social Security card.

v     Applicants must be age 50 or over.

v     Applicants must provide (1) month’s income verification, i.e. check stubs, social security income letter or a copy of the first page of prior year Income Tax Return and the Employer Verification of Income form.  Must include all household members’ income verification.

v     Applicants must reside within the Muscogee (Creek) Nation Geographical Boundaries (Creek, Muskogee, McIntosh, Okfuskee, Okmulgee, Tuckabatche, Tulsa and Wagoner Counties).

v     Applicants must provide copy of Health Insurance Card (Medicare, Medicaid, or private insurance).

v     The Muscogee (Creek) Nation is the payer of last resort.  The Contract Provider will be responsible for collecting from third-party resources (i.e. Medicare, Medicaid, or private insurance).

v     Applicants must use one of the program contracted Optometrist or any Tribal/Indian Health Facility Optometrist.  Prior approval must be authorized before an appointment can be scheduled with a Contract Optometrist.  If using the Tribal/Urban/Indian Health Facility Optometrist applicant must provide their prescription and order form/invoice from that facility.  The prescription must be within a six-month period.

v      Applications will be processed according to order of receipt.

v      The original application must be returned; no copies or fax copy will be accepted. 

NOTE:  The Program pays $55.00 towards your eye exam and $125.00 for frame and lenses.  Any amount exceeding the amount will be the responsibility of the applicant.  CONTACT LENS ARE ALLOWABLE ONLY IF REQUIRED MEDICALLY, NOT FOR COSMETIC PURPOSES.

Please send completed application and supporting documents to:

CONTRACT HEALTH SERVICES

 ATTN:  VISION PROGRAM

 206 SOUTH GRAND, SUITE 202

 OKMULGEE, OK  74447

NOTE: CREEK CITIZENS ARE ELIGIBLE FOR THE TRIBAL VISION PROGRAM ONCE EVERY TWO YEARS AND MUST CONTRIBUTE A $10.00 CO-PAYMENT TOWARD THE PURCHASE OF EYEGLASSES.  CONTACT LENSES ARE ALLOWABLE ONLY IF REQUIRED MEDICALLY, NOT FOR COSMETIC PURPOSES.

THE PROGRAM PAYS $55.00 TOWARDS THE EYE EXAM AND $125.00 TOWARDS LENSES AND FRAME.  ANY AMOUNT EXCEEDING $180.00 WILL BE THE RESPONSIBILITY OF THE APPLICANT.

To download forms, please click on the following links:

Application

Verification of Income

Income Guidelines

Vendor List #1

Vendor List #2

- William James

Please do not hesitate to contact us at the numbers below with any questions you may have regarding the services offered by the Health System or eligibility requirements for those services.

(918)756-4333

(800)782-8291 

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