State issued driver’s license, state issued )D card, current student )D with picture, current employee job badge with picture , |
passport with picture, U.S. )mmigration documents with picture, credit card with picture, foreign consulate )D card with |
Identification (ID) (One for you and your spouse) |
|
|
|
|
not for married women , |
picture. )f picture )D is not available, two of the following proofs may be used: birth certificate |
marriage license, social security card, other federal documents showing identity, hospital or birth records, adoption papers or |
records, voter’s registration card, current wage stubs, Medicare card or current Medicaid. |
days: |
|
One proof of address that shows your name or your spouse’s name dated within the last |
|
Utility bills, school record for children under age |
, mortgage coupon, credit card statement, printout from )RS of most |
Address |
|
|
|
|
|
|
current year’s tax filing, certification documents or benefit checks from Social Security Administration or Texas Workforce |
Commission, certification documents from SNAP |
Supplemental Nutrition Assistance Program, formerly known as food |
stamp , Medicaid or Medicare, letter from recognized social services agency, business mail, statement from a licensed child |
care provider, (arris County (ospital District Residence Verification Form completed by a reliable person not living in the |
same household or (arris County (ospital District Rental Verification Form completed by landlord. |
|
OR |
|
|
|
|
|
|
One proof of address that shows your name or your spouse’s name dated within the past year: |
|
|
Current lease agreements, department of motor vehicles record, property tax documents, automobile insurance documents |
non expired , automobile registration or voter’s registration card for current year. |
|
|
|
Current check stubs, child supports, current )RS |
|
tax return, (arris County (ospital District Statement of Self |
Employment )ncome Form, (arris County (ospital District Wage Verification Form, Social Security, Retirement or Veteran |
Income for |
past 30 days of each household member |
|
|
|
|
Affairs letter or check, unemployment benefit records or (arris County (ospital District Statement of Support Form if no |
income. |
|
|
|
to |
, Social Security Award letter |
Birth certificate, baptismal record, proof of full time school enrollment for students aged |
with dependent’s names, school documents or insurance documents showing names of parent and child, U.S. )mmigration |
Household members (one for each) |
|
|
|
|
|
applications with dependents’ names, divorce or child support decree, baby’s Popras form, birth fact record or hospital |
armband for infants under days old, current Medicaid or Death Certificate for previous household members. |
You must bring documents from the U.S. Citizenship and )mmigration Services. |
|
|
|
Immigration Status (for each household m mber) |
|
|
|
|
Please bring current proof of Medicaid, C()P, C()P Perinatal, Medicare or health insurance. |
|
|
|
H lth Care Cov rage (for each household memb |
) |
|
|
|
|
You must provide proof of your resources and liabilities current bank statement, credit card bills, loans, etc. on a Medicare |
Asset Form. |
Medicare patients |
|
|
|
|
|
Resources f |
|
|
|
or SS) Supplemental Security |
*You must apply for C()P, C()P Perinatal, Medicaid, TANF Temporary Assistance for Needy Families |
)ncome benefits if you qualify. |
|
|
|
|
|
)f you need help getting proof, the interviewer can help you. |
|
|
|
/ |
Page |
|
|
|
|
|