In order to verify your eligibility and complete your application, you will need to submit certain required documents before or during your appointment. Documents should be submitted for each adult household member, if applicable.

Each household member will be required to provide:

  1. Personal identification
  2. Proof that you live in San Francisco
  3. Proof of household income

These documents help the Assistor determine if you are eligible for Healthy San Francisco or for another public health insurance program. Your application will be considered incomplete until all required documents are submitted.

You may submit all the required documents electronically using the form below. Otherwise, you will need to provide them during your enrollment appointment. Documents for all household members can be submitted together.

  1. Personal Identification: ONLY ONE of the following documents is needed. Your personal identification must contain a photograph. For example:
  • State Issued Driver License or ID
  • San Francisco City ID Card
  • U.S. Passport
  • Student Picture ID
  • Certificate of Naturalization N-550/N-570
  • Foreign Passport/ID
  • Permanent or Temporary Residency Card
  • Consular ID
  • Employment Authorization Card or ID
  • Certificate of Indian Blood/U.S. American Indian tribal document


  1. Proof that you live in San Francisco: ONLY ONE of the following documents is needed. Your proof of physical address must show your name. For example:
  • State Issued Driver License of ID
  • San Francisco City ID Card
  • Pension Check or Statement
  • SSI Award Letter
  • General Assistance Letter
  • DMV Registration
  • Current Pay Stub
  • Utility Bill
  • Affidavit of Support
  • Social Security Award Letter


  1. Proof of Income. For EACH member of the household, please provide the most recent copy of one of the following documents as proof of income. For example:
  • Current Pay Stub
  • Most Recent 1040 Tax Return
  • Unemployment Benefits Statement
  • Rental Income Receipts
  • Worker Compensation Statement
  • Veteran’s Statement
  • Profit and Loss Statement for Self-Employment
  • Signed Statement from Employer


If you need to submit an Affidavit of Support, Signed Statement from Employer, Profit and Loss Statement, or an Authorized Representative Form, these are available on this page under "Need Templates?".