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ACCESSING HEALTH AND HUMAN SERVICES PROGRAMS

MOST COMMONLY REQUESTED DOCUMENTS

CALIFORNIA CHILDRENS SERVICES (CCS) (800) 288-4584

CHILD HEALTH & DISABILITY PREVENTION PROGRAM (CHDP) (800) 993-2437

HEALTHY KIDS (888) 4LA-KIDS

HEALTHY FAMILIES (888) 747-1222

MEDI-CAL (877) 597-4777

MEDICARE (800) MEDICARE

CALWORKS (877) 481-1044

CASH ASSISTANCE PROGRAM FOR IMMIGRANTS (CAPI) (877) 481-1044

FOOD STAMPS (877) 597-4777

GENERAL RELIEF (877) 481-1044

IN-HOME SUPPORTIVE SERVICES (IHSS) (888) 944-IHSS

WOMEN, INFANTS AND CHILDREN (888) WIC-BABY

CHILD SUPPORT SERVICES (323) 890-9800

MENTAL HEALTH (800) 854-7771

HEALTH

INCOME SUPPORT

OTHER SERVICES

PROGRAM FEES/CO-PAYMENT

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Required Documents

Birth Certificate (for each applicant)

Resident Alien Card (If not a US Citizen) or other residency documents Proof of California Residency: Driver’s License, State ID Card or current letter mailed to you at your address Social Security Card

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Medicare Card or other health insurance card Marriage Certificate

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School Enrollment/Attendance Papers

If pregnant or applying for unborn child, Proof of Pregnancy Proof of Income

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Child/Spousal Support: child support and/or spousal support award letter, copies of check received or statement from Child Support Services Department for last month Proof of Resources: all current bank statements, property statements, auto registrations, life and/or burial insurance policies, life estate agreement Proof of Expenses/Proof of Deductions: work clothing and transportation costs, current taxes, medical insurance, etc.

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PROOF OF INCOME & EXPENSES: If you have any of the documents listed in the two sections below bring them with you.

INCOME

EXPENSES

If employed: copy of most recent pay stub with name of employer and person who worked OR Signed statement from employer with gross monthly income stated and dates received If self-employed: copy of last year’s federal income tax return (with Schedule C) or last 3 months’ profit and loss statements

For care of a child or disabled adult: receipts, bill or cancelled checks that show name of the person cared for, cost of care, and the name of the person who paid for the care

For housing and utility costs: receipts or bills that show user’s name and amount due

If disabled or retired: copies of award letters or bank statements showing

For medical costs for the disabled or persons age 60 or older: bills, receipts, medical

direct deposits

insurance premiums, or cancelled checks that show the name of the person who incurred the expense, cost and name of person who paid for the care

If currently receiving benefits: proof of the amount (i.e. unemployment insurance, Social Security, workers compensation, veteran income checks or disability insurance) If income from a loan: copy of loan papers with the name of person who is

For court ordered support payments: receipts, cancelled checks or money orders that show who the payment was for and the amount paid

For self employed: signed receipts, cancelled checks or statements from whom you

receiving the loan, the amount and current balance

get your supplies

T h i s f o r m i s a v a i l a b l e a t h t t p : / / w w w . l a d p s s . o r g / d p s s / m c r d _ f o r m s . c f m

rev. 5/10

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