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 Proof of Patient Identification
- Driver's license or DPS ID card
- Birth Certificate (children under 18)
- Employee Identification card (with picture)
- School Identification card (with picture)
- Immigration documentation for all applicable household members: Resident alien cards (front and back), Visas and or Passports
Social Security Number for all applicable household members.
Provide (all applicable)
- Most recent checking and savings account statements
- Entire 1040 Tax Return Form with: Schedule C, Partnership tax form 1065, Schedule K-1, Schedule F, W2 etc.
Proof of Employment and Income
- Four most recent payroll check stubs
- Employment Verification form
- Current award letter / copies of checks: SSI, RSDI, VA, Soc. Sec., TANF
- Workman's Compensation
- Employer statement of earnings on letter head
- Court orders/check for Child Support /Alimony
- Unemployment award letter/check stubs
Verification sources of no income (all applicable)
- Food Stamp/TANF and Housing Assistance award letters
- Statement from Homeless Shelter where patient resides and verifying unemployment.
- Verification of Assistance form with notary seal and all of the following proofs from the person providing assistance:
- Driver's license or DPS ID card
- Utility bill
- Proof of income
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Proof of Patient Residency (minimum of two)
- Utility, telephone and cable bills
- Lease agreement, rent receipt, mortgage statement
- Auto, Life, Homeowners/Renter's Insurance Documents
- County, State/Federal agencies Correspondence
- Retirement Plan Documents, Attorney Correspondence
- Texas Department of Motor Vehicle Records
- Statement from Homeless Shelter
Proof of Insurance (for all household members)
- Front and back of Medical/Dental Insurance cards
Proof of Self Employment (No taxes withheld from income)
- Self Employment Form (1 form each month)
- Entire 1040 Tax Return Form with: Schedule C, 1099, Partnership Form 1065, Schedule K-1, Schedule F etc.
- Business ledgers/Accountant s statement listing income and expenses for the last 12 months
- 12 months of check stubs, receipts, or logs for income received: babysitting, contract/sub-contract work, landscaping, day labor work etc.
Acceptable sources to verify deductions
If desiring to claim deductions for child care, alimony or child support paid out:
- Statement listing last four payments to provider
- Last four canceled checks
- Copy of divorce decree stating amount owed
- Statement from Attorney General's office
- Statement from ex-spouse itemizing payments
Assets, Debts & Liabilities
- Certificate or dividend statement
- Car title / make, model and value
- Individual Retirement Account
- Proof of insurance policies
- Property tax statement or deed/title
- Oil, gas, mineral rights (bring statement)
- Car loan agreement or statement
- Unpaid medical bills
- Lending institutions account #'s & available credit line
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