Documentation - What to Bring with You When You Apply
If you have any of the items listed below be sure to bring all the material with you. This list is
not intended to imply that these are the only documents you can provide. If you have other
documents, which will verify the item, bring it with you when you come in.
Identity:
You must prove who you are
· Photo ID
· Social Security Card
· Driver’s License
· Birth Certificate
· U.S. Passport
· Credit Card with Signature
Social Security #:
A Social Security Number (SSN) is not required for Emergency Medicaid –
Undocumented Alien (EMU)
· Social Security Card
· SS-5
· Official Statement from SSA
· Social Security Check
· Health Insurance Card
· Armed Forces Serial Number
Age:
You must prove the age of each person applying for assistance, where appropriate.
· Birth Certificate
· Insurance Policy
· Baptismal Certificate
· Census Records
· Hospital Records
· School Records
· Adoption Records
· Statement-Another Person
· Naturalization Certificate
· Physician Statement
· Driver’s License
· Official SSA Notices
Marital Status:
You must prove if you are married, divorced, separated or widowed
· Marriage/Death Cert.
· Statement-Clergy
· Separation Agreement
· Divorce Decree
· Census Records
· Newspaper Notice
· SSA Records
· Statement-Another Person
· Veteran’s Administration Records
Citizenship & Alien Status:
You must prove lawful permanent U.S. residence or residence under color-of-law for
each person applying, unless they are applying for Emergency Medicaid –
Undocumented Alien (EMU) only and assistance for pregnant women
· Birth Certificate
· Baptismal Certificate
· Naturalization Certificate
· Hospital Records
· U.S. Passport
· Military Service Records
· Voter Registration
· Immigration & Naturalization Services Documentation
· Evidence of Continuous U.S. Residence Since 1/1/72
Household Composition/Size:
You must prove who is living with you.
· Home Visit
· School Records
· Service Records
· Statement from Clergy
· Statement from Non-Relative Landlord
· Statement from Other Persons
Shelter Expenses:
You must prove how much it costs you to live where you do. Each shelter item may need
to be documented separately
· Current Rent Receipt
· Current Lease Agreement
· Sewer & Water Bills
· Mortgage Book/Records
· Telephone Bills
· Utility/Fuel Bills
· Landlord Statement
· Property/School Tax Records
· Homeowner’s Insurance Policy
Residence:
You must prove where you live.
· Current Rent Receipt
· Current Mail
· School Records
· Mortgage Book/Records
· Other Records
· Another Person’s Statement
· Physician’s Statement
· Statement from Landlord
Absent Parent:
If the parent(s) of any child in your home is not living with you, you must prove it.
· Death Certificate
· Newspaper Notice
· Burial payments
· Survivor’s Benefits
· Insurance Company Records
· Hospital Records
· Divorce Papers
· Agency Case Record
· Veteran’s Administration and/or Military Records
· Institutional Records
· Another Person’s Statement
· Proof of Remarriage
Disability/Pregnancy/Incapacity:
If you or anyone living with is sick/pregnant, you must provide proof.
· Physician’s Statement
· Proof of Social Security Disability Insurance (SSDI)/Supplemental
Security Income (SSI) Benefits
· Physician’s Medical Pregnancy or Incapacity Statement
Shelter/Utilities/Medical Expenses:
Rent, Utilities, Medical Bills
· Copy of each bill to prove the amount owed, period of services and
the provider
Income – Earned/Unearned:
From Employer:
· Current Wage Stubs
· Pay Envelopes
· Collateral Contact - Employer
· Business Records
· Current/Last Tax Records
· Statement from Provider or Dependent Child Care
Self-Employment:
· Records & Related Materials
· Accounts Receivable & Payable
· Current /Last Tax Return
Child Support:
· Statement from Family Court
· Canceled Checks or Receipts
· Statement from Payer
· Child Support Enforcement Agency Records
Social Security:
· Current Award Letter
· Current Benefit Check
· Official SSA Notices
Unemployment Benefits:
· Current Award Certificate
· Current Benefit Check
· Dept. of Labor Notices
Veterans Benefits:
· Current Award Cert.
· Current Benefit Check
· Veteran’s Admin. Notices
Rental or Room & Board Income:
· Contribution Check - copy
· Roomer/Boarder/Tenant Statement
· Tax Records
Interest/Dividends:
· Bank or Credit Union Records
· Statement from Broker
Educational Grants/Loans:
· School or Bank Statement
· Award Letter
· Statement from Educational Admin. Agency
Worker’s Compensation:
· Award Letter
· Check Stub
Other:
· Current Award Letter
· Current Benefit Check
· Official Notice from Source
Dependent Care and/or Other Expenses:
You must provide proof, if you pay court-ordered child support, childcare, recurring
loans, or pay for services of a home health aid or attendant.
· Statement from Day Care Center or Other Provider
· Statement from Aide or Attendant
· Canceled Checks or Receipts
· Court Order
Resources:
Health Insurance – if you or anyone applying has health insurance coverage, even if
paid by someone else, you must prove it:
· Insurance Policy
· Insurance Renewal Bill
· Insurance Card
· Provider Statement
· Medicare Card
· Separation/Divorce Decree
Cash on Hand:
· Statement from Household
· Statement from Nursing Home
Bank Accounts:
· Current Bank Statement
· Current Credit Union Statement
Stocks, Bonds, Certificates of Deposit:
· Stock/Bond Certificate(s)
· Financial Institution’s Statement
Income Tax Refund or Earned Income Credit (EIC):
· Refund or EIC Check
· Statement from Tax Office
Life Insurance:
· Insurance Policy
· Insurance Company Statement
Real Estate - other than the house you live in:
· Deed
· Real Estate Broker Statement
· Current Appraisal from Dealer
· Public Real Estate Records
· Real Estate Listing
Motor Vehicle(s):
· Registration
· Title of Ownership
· Current Appraisal from Dealer
· Financing Data
Lump Sum Payment(s):
· Statement from Source
· Lump Sum Check - copy
Other:
· Household Statement of Value
· Sales Slip
· Insurance Appraisal
· Dealer Estimate
Referrals:
Drug/Alcohol Treatment:
· Statement from Provider of Treatment
Employment Services:
· Statement from Employment Service
Other:
· If you have something else, bring in all the papers and we’ll take a look
at them