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


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Forms Needed

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

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