Logo Homepage JDC

Forms for download (All forms are in Hebrew

Addresses for submitting forms

  • Bituach Leumi – Submit forms at the Bituach Leumi branch of the senior person’s place of residence. For list of branches click here

  • Ministry of Health – Submit forms at regional Health Bureau of the senior person’s place of residence. To find regional Health Bureau click here

    • Ministry of the Interior, Population & Immigration Authority – Submit forms at the Permit Division – Nursing Dept., at the following addresses:
    • Jerusalem – 42 Agripas St., 5th floor, Kiach Building, PO Box 28346
    • Tel Aviv – 125 Menachem Begin St. 2nd floor, Kiryat HaMemshala. PO Box 7105, Tel Aviv 61070
    • North – 22 Herzliya St., 3rd floor, Haifa 3330125
    • Sharon – 140 Weizmann St., 4th floor, Kfar Saba
    • South – 4 Hatikva St., Government City Mall (Kenyon Kiryat Hamemshala) , Building 5, 5th floor, Beer Sheva

    National call center – *3450

Caring Family

Forms, payments and fees for acquiring a permit to employ a foreign worker 

  • Claim for special services pension – Submit this form to Bituach Leumi to apply for a special pension for a person already receiving a general disability pension, who is not of retirement age, but requires supervision and/or assistance in basic daily tasks. 
  • Request for dependence assessment – For seniors who wish to employ a foreign worker but are not entitled to the long term nursing care benefit due to high income. The dependence assessment will determine whether their condition warrants a permit to employ a foreign worker. Submit this form to the Permit Division of the Population & Immigration Authority at the Ministry of the Interior (see above). 
  • Request for suspending permit to employ a foreign worker – For people who have obtained a permit to employ a foreign worker but do not wish to use it. Submit this form to the Permit Division of the Population & Immigration Authority at the Ministry of the Interior (see above). 

 

How to find a nursing home and get assistance in paying for it 

Forms for applying to the Ministry of Health for participation in funding a patient in a nursing home, in a department for nursing care/mentally frail persons (request for ‘code’) 

Submit forms to the Regional Health Bureau in the elderly person’s place of residence. To find the Regional Health Bureau near you click here.

  • Questionnaire: declaration of patient and/or his/her spouse – in order to determine the degree of participation in funding chronic nursing care at a nursing home. The form must be signed in the presence of an attorney. In some regional health bureaus a meeting with a lawyer may be arranged. 
  • Questionnaire: declaration of patient’s son/daughter – in order to determine the degree of participation in funding chronic nursing care at a nursing home. The form must be signed in the presence of an attorney. In some regional health bureaus a meeting with a lawyer may be arranged. 

Guidance & forms for applying for guardianship 

Documents needed to apply for guardianship during long-term hospitalization 

 

Documents needed to apply for guardianship in the community – of a person living at home 

 

Bituach Leumi

Submit forms to the branch of Bituach Leumi near the elderly person’s place of residence. For list of branches click here.

  • Claim for disability pension – Application for general disability pension due to illness or functional deterioration following health incident, before retirement age.
  • Claim for special services pension – Application for a special pension for a person already receiving a general disability pension, who is not of retirement age but requires supervision and/or assistance in basic daily tasks.  
  • Claim for supplementary income – For seniors with no additional income or minimal income beyond the old age pension (Note: includes 50% discount on medications).

 

Ministry of Health 

 

Rehab & Mobility Aids – Ministry of Health

Applications for financial participation in purchasing rehabilitation and mobility aids – to be filled by social worker and physician/nurse.

The forms must be submitted to the Regional Health Bureau at the senior’s place of residence. To find the Regional Health Bureau near you click here.

 

Geriatrics – Ministry of Health 

The forms must be submitted to the Regional Health Bureau at the senior’s place of residence. To find the Regional Health Bureau near you click here.

Forms needed for application for participation of the Ministry of Health in funding hospitalization of a person in a nursing home, nursing care/mentally frail department.

  • Questionnaire: declaration of patient and/or his/her spouse – in order to determine the degree of participation in funding chronic nursing care at a nursing home. The form must be signed in the presence of an attorney. In some regional health bureaus signing before an attorney may be arranged. 
  • Questionnaire: declaration of patient’s son/daughter – in order to determine the degree of participation in funding chronic nursing care at a nursing home. The form must be signed in the presence of an attorney. In some regional health bureaus signing before an attorney may be arranged. 

Ministry of the Interior – Population & Immigration authority

Submit forms at the Permit Division – Nursing Dept., at the following addresses:

  • Jerusalem – 42 Agripas St., 5th floor, Kiach Building, PO Box 28346
  • Tel Aviv – 125 Menachem Begin St. 2nd floor, Kiryat HaMemshala. PO Box 7105, Tel Aviv 61070
  • North – 22 Herzliya St., 3rd floor, Haifa 3330125
  • Sharon – 140 Weizmann St., 4th floor, Kfar Saba
  • South – 4 Hatikva St., Government City Mall (Kenyon Kiryat Hamemshala) , Building 5, 5th floor, Beer Sheva 

National call center – *3450 

  • Request for dependence assessment – For seniors who wish to employ a foreign worker but are not entitled to the long term nursing care benefit due to high income. The dependence assessment will determine whether their condition warrants a permit to employ a foreign worker.

Ministry of the Interior

Ministry of Transport 

 

Ministry of Finance 

Information for family caregivers 

All forms in this document are up-to-date for February 2016.