Bank statement
Bank website/app webpage screenshot
Childcare
Childcare receipt/statement which includes:
Amount
Date paid
Name(s) of person(s) care was provided for
Signature of provider and date
US Citizenship
Birth certificate
Passport
Baptismal certificate (with date and place of birth)
Statement of witness to birth
Certificate of naturalization
Certificate of citizenship number for derived citizens
Any proof of U.S citizenship
Disability
Benefits Award Letter (Disability, Supplemental Security Income (SSI), State Supplementary Payment (SSP), etc.)
Doctor's note
Hospital records
Employer statement or termination notice
Proof of Worker's Compensation
Income
Pay stubs for the last 30 days
Statement from your employer
Copy of last year's tax return
Child support/Alimony
Award letters (Unemployment, Veterans, Social Security, etc.)
Statement from college financial aid office
Immigration
Immigration papers/forms/cards (copy of both sides)
Other proof from immigration (USCIS), such as: work authorization, letter of decision or court order on your case, etc.
All documents and forms must be verified through the Systematic Alien Verification for Entitlement (SAVE)
Immunization
Statement that immunizations are against your beliefs
Statement from parent or caretaker relative explaining why you can't get immunizations
Statement from doctor that immunization records are not available
Copy of shot record
Statement from doctor that immunizations are not in the best interest of the child's health
Medical
Medical bills, receipts, or itemized statements
Medical transportation bills or receipts
Health or dental insurance policies or premiums
Medicare card (for Medi-Cal only)
Proof of Identification
Passport
Driver's License/Real ID
School ID
Military ID
Social security card
Proof of application (if no SSN exists)
Resources
Most recent mortgage bill(s)
Settlements such as lawsuits and insurance claims
Most recent retirement account statement(s)
Life insurance policy, stocks, bonds, IRAs
Property deed
Statement of joint ownership
Burial plots/crypts
School Information
Report card
Class schedule or syllabus
Registration schedule or fees
Financial aid
College or university enrollment
Written statement
Attendance records
Certificate of completion or diploma
Vehicle Registration
Motor Vehicle registration certificate
Utilities or Household Expenses
Rental agreement
Bill or other document(s) with name and address
Rent or mortgage receipt
Utility bill
Welfare to Work or Travel Claims
County/State forms
County mileage claim forms
Employer contacts (Job Search)
Work schedule/timecard
WEX (work experience) documents
Supportive service requests
Card No.
5077 1904 4292 6958
CAL FRESH / SYNERGY 858 585 0297
ENROLMENT # 11220901
Medi-Cal
DENTI CAL
MEDICAL RENEWAL
866 262 9881
WESTERN DENTAL CLAIM EXPIRES
11/21/23
5077 1904 4292 6958
CAL FRESH / SYNERGY 858 585 0297
ENROLMENT # 11220901
Medi-Cal
DENTI CAL
MEDICAL RENEWAL
866 262 9881
WESTERN DENTAL CLAIM EXPIRES
11/21/23
Card No.
5076 9300 8102 1673
case no 401776863 12/18/23
800 699 9075
(30 MIN DRIVE)
DEPT OF HUMAN SVCS
8 TO 5
11826 NE GLISAN ST
PORTLAND OR 97220
to set up account
833.978.1073
EBT Renewal
https://www.oregon.gov
5076 9300 8102 1673
case no 401776863 12/18/23
800 699 9075
(30 MIN DRIVE)
DEPT OF HUMAN SVCS
8 TO 5
11826 NE GLISAN ST
PORTLAND OR 97220
to set up account
833.978.1073
EBT Renewal
https://www.oregon.gov
Medi-Cal
case # 1bhj859
worker 37l50c4f02
866.262.9881
211 san diego for programs
case # 1bhj859
worker 37l50c4f02
866.262.9881
211 san diego for programs
211
Care Oregon
503.416.3731
Trillium
877.600.5472
OHP Client Services
855.226.6170
800.273.0557
One.Oregon.Gov
ap tech team
833.978.1073
MEDICAID
Care Oregon
503.416.3731
Trillium
877.600.5472
OHP Client Services
855.226.6170
800.273.0557
One.Oregon.Gov
ap tech team
833.978.1073
MEDICAID
Moda Dental
800.342.0526
other dental:
Capital
Advantage
800.342.0526
other dental:
Capital
Advantage
