Please fill out the DSHS Family & Community Health Services Division HOUSEHOLD ELIGIBILITY FORM and bring the following documentation to your interview. Para español, haga clic aquí.
Income Verification – All that apply to you
- Three consecutive current paycheck stubs, earnings printout, or Employment Verification Form.
- Letter of Support signed and dated.
- Award printout from Unemployment, Social Security, SSI, Workers Compensation, retirement, VA benefits, TANF payments and educational benefits (grants, scholarships).
- Self-Employment Income: Current IRS Return including all Schedules-C, D, E, etc; or
- Current Self-Employment Statements - income and expenses. Receipts, invoices, etc.
- Any other income: from property sales/rental, dividends, interest, royalties, etc.
- Documentation of legally obligated Child Support payments made, or payments received
- Receipts for Childcare payments made (or received).
Proof of Residency – Physical Address - One of the Following listed below dated within the past 30 days.
- Current mail addressed to the applicant
- Utility bill or rent receipt, dated with the physical address
- Valid Texas Driver’s License
- Current Auto Insurance listing physical address
Other Needed Documentation
- Picture ID (Driver’s License, ID, Residence Card or Passport)
- Birth Certificates for children and adults with no current ID
- Court Documents showing Guardianship, CPS placement documents
- Current voter registration
- Social Security card
- Medicaid, Medicare, HTW and CHIP cards
- Other Private or Group Insurance: VA, Tri-Care, BC/BS, Aetna, etc.
- Disability Documentation indicating the current status of your SS/SSI claim.
- Print out or letter showing the date of Medicare eligibility
- Documentation of Work-Related Injury or Motor Vehicle Accident, if applicable.
***These are the basic requirements. Other documents may be requested.
Please have your spouse sign a Statement of Applicants Rights and Responsibilities form and bring everything that applies to your situation.
