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Please have available any of the following documents that pertain to you and your family for a successful interview and print this page before continuing for a pre-appointment checklist.
To have a successful Financial Assistance appointment, please have the following documents available with you during the telephone or video appointment:
_____ Driver’s license, State ID, Military ID or United States Passport
_____ Permanent Resident Card for all family members
_____ Visas, passport or naturalization citizenship documents
_____ Birth certificates of minor children
_____ Marriage Certificate, Divorce Decree, or Death Certificate
_____ Letter of Guardianship and or Power of Attorney
_____ Utility Bill, Commercial Mailing received in the past 60 days
_____ Lease or Rental Agreement signed or received in the past 60 days
_____ Letter describing proof of support and or residency signed and dated
_____ Prior years Federal Tax Return (Personal, Corporate, Partnership Tax) including all W2’s and or 1099’s
_____ Paystubs from each employer for the last three (3) months
_____ Proof of lost income in the past three (3) months. (employment termination letter, benefit termination letter)
_____ Statement of Gross income from the following agencies:
* Veteran’s Administration
* Unemployment Compensation
* Short Term/Long Term Disability
_____ Statement of income from:
_____ Annual statement of earned interest/capital gains for bank accounts, stocks, bonds, CD, IRA
_____ Monthly gross profit statement for prior 12 months if self-employed, rental property owner, doing odd jobs, business partnership, or corporation owner
_____ Copy of the following program statements:
* Medicaid award/denial letter or proof of Medicaid case closed from another state
_____ Completed and signed FAP/ HCAP Application
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