Apply for Free Health Care Services - Checklist


Use this checklist to help you collect the information you will need to enroll your children in the Medical Care for Children Partnership (MCCP) / Kaiser Program.

  • One full month of pay stubs (last month or this month) for each employed household member or a written record of weekly earnings for anyone who receives cash for day labor work.
  • Proof of any unearned income such as Unemployment, disability benefits, alimony or child support. Examples are: copy of the check, bank statements for direct deposits, award letters or a divorce decree.
  • Signed copy of your most recent federal tax return and all schedules for yourself. If you or children are claimed on another person’s taxes, please return the person’s federal tax returns that claimed you or your children.
  • Two months of most current bank statements for each account.
  • Proof of your address such as a current lease or mortgage statement, car registration or current utility bill.
  • Proof of child’s date of birth such as a birth certificate or passport.
  • Shot records for each child applying.


You will also need to complete and sign the following forms

 

¿Habla Español?




Forms Needed
(PDF's)

Back to the How to Apply Page




Back to Top

Fairfax County Department of Family Services
[ 12011 Government Center Parkway, Fairfax, VA 22035 ]
[ 703-324-7500 ]

Contact Fairfax County: Phone, Email or Twitter | Main Address: 12000 Government Center Parkway, Fairfax, VA 22035
Technical Questions: Web Administrator

ADA Accessibility | Website Accessibility
Awards | FOIA | Mobile | Using this Site | Web Disclaimer & Privacy Policy | Get Adobe Reader
Official site of the County of Fairfax, Virginia, © Copyright 2013

Website Feedback Website Feedback    Globe with various flags representing Web site language translations   Language Translations

Return to Graphic Version