Apply for Free Health Care Services - Checklist
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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.
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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.
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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.
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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.
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Two months of most current bank statements for each
account.
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Proof of your address such as a current lease or
mortgage statement, car registration or current utility bill.
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Proof of child’s date of birth such as a birth
certificate or passport.
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Shot records for each child applying.
You will also need to complete and sign the following forms
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Forms Needed
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