Required Documents
During your application appointment, you will be required to provide the following documentation:
- Personal identification
- Proof of residency
- Proof of household income and assets
This documentation is in addition to the information provided by your employer because it helps the Application Assistor determine if you are eligible for Healthy San Francisco or for a public health insurance program. The application process is considered incomplete unless all required documents are submitted.
1. Personal Identification
Documents must contain a photograph. ONLY ONE of the following documents is needed:
- CA Driver License or ID
- U.S Passport
- Student Picture ID
- Certificate of Naturalization N-550/N-570
- U.S Mariner Card
- Permanent or Temporary Residency Card
- Consular ID
- School Record w/date & Place of Birth/parents
- Cert. of Indian Blood/US Amer. Ind. tribal doc.
- Employment Authorization Card or ID
2. Proof of Residency
Documents must have the applicant's name. ONLY ONE of the following documents is needed:
- CA Driver License or ID
- Current Pay Stub
- Bank Statement
- Current Tax Return Statement
- Utility Bill
- SFUSD School Registration
- SSI Awards Letter
- DMV registration
- Pension check / Statement
- Social Security Award Letter
- General Assistance Letter
- affidavit of Support - This is a form that someone you live with can sign to vouch for your residency. They will need to provide one of the above items in their name. (download form)
3. Proof of Income and Assets
ALL documents that exist for any member of the applicant's household must be provided:
- Current Pay Stub
- Current Tax Return
- Signed Statement From Employer (download form)
- Bank Statement
- Rental Income Receipts or 1040 tax return
- Bank Book / Annuity Statement
- Unemployment Benefits Statement
- Veteran's Statement
- Worker Compensation Statement
- Copy of Award Letter
- Certification from the issuing institution of any Non-retirement stocks, bonds, or certificates of deposit.
