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 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.

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 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 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 a sample Signed Statement from Employer letter

Click here for a sample Profit and Loss Statement for Self-Employment 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)
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.