Proof of Income - bring all proof of income for everyone in the household received within the last 30 days
If you are currently receiving Medicaid, SNAP, or TANF, bring proof of your participation:
- DHHS Notice of Action Form
- Medicaid, SNAP, TANF cards
If you are not currently receiving Medicaid, SNAP, or TANF, bring proof of all incomes sources for the last 30 days including:
- Pay stubs
- Self-employment documents: W-2 forms; most recent income tax statement; accounting records
- Military LES - Leaving & earning statement
- Alimony or child support statements
- Unemployment or disability income
- Social security statements (award letter or bank statements)
- Income letter from your employer if paystub is not available
- Retirement, pensions, annuity payments including payments for veterans
- Disability income payments including veteran's disability payments
- Workers compensation benefits
- Net royalty payments; lottery winnings or prize money over $1,500
- Inherited cash
- Other income sources, contact your clinic