Eligibility Application
Eligibility Application
You must be prepared to upload all proper supporting documents, including a Valid Photo ID, Proof of Address, Proof of Household Gross Income from past 30 days, and Proof of Dependents, (if applicable). See Checklist for more information!
If you need assistance with applying for Medicaid, CHIP, Healthy Texas Women, or SNAP applications, you can skip these steps and call us today to make an appointment with an Eligibility Specialist nearest to you.
MyCHN Financial Screening Check List
If all supporting documents were not uploaded above, please ensure that all required documents are available at the time of your appointment. Refer to the Financial Screening Checklist for additional details. Failure to provide the necessary documents before or during the appointment will result in the need to schedule a new appointment.
What supporting documents should I bring?
- 1. Identification. Must provide one of the following:
- Must be photo ID
- Texas Driver's License
- Texas Identification Card
- Passport, Visa, or ID from another country
- 2. Proof of Address. Must provide one of the following:
- Utility Bill (water, light, cable, etc.)
- House or Lease Agreement
- 3. Proof of Income
- If Employed. Must provide one of the following:
- Weekly Pay - Most recent 4 consecutive check stubs
- Bi-Weekly Pay - Most recent 2 consecutive check stubs
-
If no check stubs are available, must provide one of the following:
• Taxes from the last two consecutive years (no W-2’s)
• Employment Verification (Form 3049) – handwritten letters are not accepted
- If Self-Employed. Must provide one the following:
- Statement of Self-Employment (Form 3051) and 30 days of receipts
- Taxes from the last two consecutive years. If no taxes, provide additional proof: Bank Statements, Invoices, Receipts
- If Unemployed. Must provide ALL of the following:
- Any other Income. Must provide all the following, if applicable:
- Any Award letters: Social Security, Pensions, Retirement, etc.
- Child Support
- 4. Proof of Dependents. Must provide one of the following:
- Under 18 years old
- Birth Certificate
- Social Security Card
- Health Insurance/Medicaid/CHIP Card
- Taxes (most recent)
Note: Form 3049, Form 3051, Notarized Letter of Unemployment and Statement of No Income – these forms are
available on our website at www.mychn.org
Other Forms
