Necessary Documents to Enroll

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

  1. Personal identification
  2. Proof of San Francisco residency
  3. Proof of household income

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 ID San Francisco ID Card
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 with date & place of birth/parents Employment 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. Document must be dated within 45 days of the applications submission date.

State Issued Driver License of ID Current Pay Stub
Pension Check or Statement Bank Statement
General Assistance Letter DMV Registration
SFUSD School Registration 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 vouch for your residency.  They will need to provide one of the listed items in their name.  (Click here to download the form)

Individuals living temporarily in San Francisco on an active visa (student visa or tourist visa) are not eligible for Healthy San Francisco.

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. Document must be dated within 45 days of the applications submission date.

Current Pay Stub Current 1040 Tax Return
Signed Statement from Employer Rental Income Receipts
Unemployment Benefits Statement Veteran’s Statement
Worker Compensation Statement Copy of Award Letter
Profit and Loss Statement for Self-Employment

Click here for how to read paystub/bank statement guide

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. Authorized Representative: If you would like to appoint someone to assist you with your application, communicate, and make decisions on your behalf in relation to your program participation, please complete the Authorized Representative Form with the person you would like to appoint.

Click here for a sample Authorized Representative Form

*Additional documentation may be required.