Required Documents
During your application appointment, you must bring the following documentation:
- Personal identification (ID)
- Proof that you live in San Francisco
- Proof of household income
These documents help the Certified Application Assistor check if you are eligible for Healthy San Francisco or another public health insurance program. Without all these documents available during your appointment, you can’t finish your application.
1. Personal Identification (ID):
You need ONLY ONE of these documents. Your personal ID must have a picture of you.
Here are some examples:
| State Issued Driver License or ID | San Francisco ID Card |
| U.S. Passport | Student Picture ID |
| Certificate of Naturalization N-550/N-570 | Consular ID |
| Permanent or Temporary Residency Card | Employment Authorization Card or ID |
| Certificate of Indian Blood/U.S. American Indian tribal document |
2. Proof that you live in San Francisco:
You need ONLY ONE of these documents. Your proof of physical address must show your name. The document must have a date that is within 45 days of the application submission date. Here are some examples:
| State Issued Driver License of ID | Current Pay Stub |
| Pension Check or Statement | Bank Statement |
| General Assistance Letter | DMV Registration |
| San Francisco City ID Card | Utility Bill |
| Affidavit of Support | Social Security Award Letter |
| SSI Award Letter |
Affidavit of Support – This is a form that someone you live with can sign to prove that you live in
3. Proof of Income.
For Each person that lives in your home, please provide the most recent copy of one of these documents as proof of income. The document must be dated within 45 days of the application submission date.
| Current Pay Stub |
Most Recent 1040 Tax Return |
| Signed Statement from Employer View a sample here. |
Rental Income Receipts |
| Unemployment Benefits Statement | Veteran’s Statement |
| Worker Compensation Statement | Copy of Award Letter |
| Profit and Loss Statement for Self-Employment View a sample here. |
If you are self-employed or own a small business, and you do not have a current tax return, you may use a Profit and Loss Statement for proof of income.
4. Authorized Representative.
An authorized representative is someone who can:
- Help you with your application
- Help communicate or share information for you
- Make decisions for you about your program participation
You can choose someone to be your authorized representative. To do this, fill out this form with them: sample authorized representative form.
You can upload all of your required documents here.
*Additional documentation may be required.