Necessary Documents to Enroll
During your application appointment, you will be required to provide the following documentation:
- Personal identification
- Proof of San Francisco residency
- 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 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|
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 Assets. For EACH member of the household, please provide the most recent copy of one of the following documents as proof of assets. Document must be dated within 45 days of the applications submission date.
|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 Letter||Mutual Fund Statement with market value|
*Additional documentation may be required.