Visitors

Necessary Documents to Enroll

During your application appointment, you will be required to provide the following documentation:

  1. Personal identification
  2. Proof of residency
  3. Proof of household income and assets

This documentation helps the Application Assistor determine if you are eligible for Healthy San Francisco or for another public health insurance program.  Your application will be considered incomplete until all required documents are submitted.

1.  Personal Identification: ONLY ONE of the following documents is needed. Your personal identification must contain a photograph. For example:

State Issued Driver License or IDSan Francisco ID Card
U.S. PassportStudent Picture ID
Certificate of Naturalization N-550/N-570U.S. Mariner Card
Permanent or Temporary Residency CardConsular ID
School Record with date & place of birth/parentsEmployment Authorization Card or ID
Certificate of Indian Blood/U.S. American Indian tribal document

2.  Proof of Residency: ONLY ONE of the following documents is needed. Your proof of residency must show your name.

State Issued Driver License of IDCurrent Pay StubUtility Bill
Pension Check or StatementBank StatementSocial Security Award Letter
General Assistance LetterDMV RegistrationSSI Award Letter
SFUSD School RegistrationAffidavit 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. (Click here to download.)

3.  Proof of Income. For EACH member of the household, please provide the most recent copy of one of the following documents as proof of income.

Current Pay StubCurrent 1040 Tax Return
Signed Statement from Employer (Click here for a sample letter)Rental Income Receipts
Unemployment Benefits StatementVeteran’s Statement
Worker Compensation StatementCopy of Award Letter

If you are self-employed or own a small business and do not have a current tax return, you may use a Profit and Loss Statement to document your income.

4. Proof of Asset. For EACH member of the household, please provide the most recent copy of one of the following documents as proof of assets.

Bank Statement (must be an actual statement, not a transaction)Bank Book/Annuity Statement
Certification from the issuing institution of any Non-retirement stocks, bonds, or certificates of deposit.Account statements for retirement accounts, such as 401K, 403b accounts (value of retirement holdings are not counted toward household assets).
Bank LetterMutual Fund Statement with market value

*Additional documentation may be required.