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Medical Support

Location:
Houston, Texas, United States
Salary:
9.50
Posted:
February 19, 2018

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Resume:

If you are applying for

If you are applying for

To get SNAP, a person must be a U.S. citizen or legal resident. More on the back Any Benefit Program

bringing or sending copies of items that apply to anyone on your case might help us review it faster. SNAP food benefits

bringing or sending copies of items that apply to anyone on your case might help us review it faster.

• Identity (proof of who you are) – Current driver’s license or Department of Public Safety ID card. If a person has the right to act for you (as your authorized representative), that person also needs

to give proof of identity.

• Immigration status – Resident card (I-551), arrival/ departure form (I-94). Or papers from the U.S.

Citizenship and Immigration Services. We need copies of the front and back of these forms.

• Veterans benefits, workers’ compensation,

or unemployment – Award letter or pay stubs.

• Social Security, Supplemental Security Income (SSI), or pension benefits – Award letter or pay stubs.

• Proof of income from your job – Last 3 pay stubs or paychecks, a statement from your employer, or

self-employment records.

• Bank accounts – The most current statement

for all accounts.

• Medical costs – Bills, receipts, or statements from health-care providers (doctors, hospitals, drug

stores, etc.). These items should show costs you

have now and costs you expect in the future.

• Rent or mortgage costs – Recent checks, check

stubs, or statement from the mortgage bank or

landlord. Renters also need to give the landlord’s name, address, and phone number.

• Military service – Current Military ID (Form DD-2), military orders, or separation papers (Form DD-214).

• Legal representative (a person who has the right to act for you on legal issues) – Power of attorney papers, guardianship order, court order, or similar court documents.

• Loans and gifts (includes someone paying

bills for you) – Loan agreements or statement from the person giving you money or paying your bills.

Must show that person’s name, address, phone number, and signature.

• Residence (proof you live in Texas) – Utility bill, driver’s license, Texas Department of Public Safety ID, rent receipt, letter from landlord (can’t be a relative).

• Dependent care expenses – Receipts, canceled

checks, or a signed statement from the person

you pay. A signed statement must show when and

how much you pay.

• Child support anyone pays – Court papers that show what you must pay for child support. For example:

divorce decree, court order, or district clerk record.

• Child support anyone gets – District clerk record. Or letter from the parent who pays showing how

much, how often and the date it is usually paid.

The letter must have the name, address, phone

number, and signature of the parent who pays.

Items we might need from anyone on your case

We try to get proof of the facts you gave about your case by checking online sources. If we need more items showing proof, we’ll let you know. We’ll tell you what items to send and how to send them. This form shows items we might ask you to send. You can upload these items using our website, YourTexasBenefits.com. If you upload any of these items now, it might help us review your case faster. We need only items that apply to anyone on your case. For example if no one has a bank account, we don’t need bank statements.

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More items we might need from you

If you need help getting these items, let us know. It’s our duty to help you. Don’t send this form back to us. Keep for your records. TANF Cash Help for Families

bringing or sending copies of items that apply to anyone on your case might help us review it faster.

• Proof of income from your job – Last 3 pay stubs or paychecks, a statement from your employer,

or self-employment records.

• Bank accounts – Most current statement for

all accounts.

• Proof a child is related to you – Legal birth,

hospital, or baptismal certificate.

• Citizenship – U.S. passport, Certificate of

Naturalization, U.S. birth certificate (copies of the front and back), hospital record of birth, or

Medicare card. If you were born in Texas, we might be able to look up your birth record.

• Child’s vaccines – Vaccine records for each child.

• Proof a child lives with you – A signed statement from your landlord or a non-relative neighbor that includes his or her name, address, and phone number.

• Child support anyone pays – Court papers that show what you must pay for child support. For example: divorce decree, court order, or district clerk record.

• Child support anyone gets – District clerk record. Or letter from the parent who pays showing how much, how often and the date it is usually paid. The letter must have the name, address, phone number, and signature of the parent who pays.

• Health insurance – Copy of the front and back

of the insurance card or policy.

CHIP or Children’s Medicaid

bringing or sending copies of items that apply to anyone on your case might help us review it faster.

• Citizenship – U.S. passport, Certificate of

Naturalization, U.S. birth certificate (copies of

the front and back), hospital record of birth, or

Medicare card. If you were born in Texas, we might be able to look up your birth record.

• Proof of income from your job – One pay stub or

paycheck from the last 60 days, a statement from

your employer, or self-employment records.

• Medical costs – Bills or statements from

health-care providers (doctors, drug stores, etc.) from the past 3 months. We only need these items

if you haven’t already paid for these services.

• Citizenship – U.S. passport, Certificate of

Naturalization, U.S. birth certificate (copies of

the front and back), hospital record of birth, or

Medicare card. If you were born in Texas, we might be able to look up your birth record.

• Proof of income from your job – Last 3 pay

stubs or paychecks, a statement from your

employer, self-employment records, or last year’s

tax return.

• Medical costs – Bills or statements from

health-care providers (doctors, hospitals, drug

stores, etc.) from the past 3 months. We only

need these items if you haven’t already paid

for these services.

Medicaid for a Pregnant Woman or an Adult

bringing or sending copies of items that apply to anyone on your case might help us review it faster. If you are applying for

If you are applying for

If you are applying for

H1858

12/2014

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