Application Supporting Documents

Residency - New York State

Include one document from this list showing your name and current address.  Documentation must be issued within the past 90 days.  A P.O. Box may be used to receive mail, but proof of your physical address is still required.

  • Utility bill (phone/fuel)
  • Lease/mortgage
  • Paystub
  • Unemployment stubs
  • Bank statement
  • Medicaid Notice of Decision
  • SSD statements
  • W-2 or 1099 (1st quarter of year)     
  • Voter registration card
  • Driver’s license
  • Clinic card or recent hospital/clinic face sheet (ONLY if we get supporting letter from SW/CM that nothing else is available)

     If the above is not available:           

  • Living with someone else:  A letter from the person(s) stating they are providing you with shelter AND proof of that person’s residency (same proof as above).
  • Homeless or in Transient Housing:  A statement signed by you, or from your case manager on agency letterhead, stating where you are staying.

Income

Proof of income for all legally responsible household members and those for whom you have a legal responsibility (i.e. spouse, children, etc.)Include all that apply.

Employed  

  • Pay stubs covering the last 30 days showing all deductions and current year-to-date earnings;

OR

  • A signed letter from your employer or you stating gross salary, hours worked, pay period covered and the expected annual earnings.

Self Employed

  • Both the most recent income tax return AND a statement signed by you estimating current annual income.

 Not Employed  

  • SSD, SSI, Disability, Survivor’s benefits, Veteran’s benefits, Unemployment benefits: A copy of current award letter(s).
  • Supported by Others: A letter from the person(s) supporting you stating they are providing you with room, board, etc.
  • Living off Savings: A statement signed by you AND a copy of your most recent account statement showing savings.