|
|
HIV DIAGNOSIS
Need Only One Document listed below. |
- Positive ELISA with confirming Western Blot test results
- RNA-PCR or Branched DNA (BDNA) test showing detectable viral load of HIV virus
|
|
|
BROWARD COUNTY RESIDENCY
Need Only One Document listed below. MUST be current/not expired with applicant’s name & current address. |
- Florida driver’s license OR Florida photo ID
- Utility bill
- Homestead exemption
- Lease and/or rental agreement
- Rent receipts noting applicant’s name, address and landlord’s name
- Letter and contact information (i.e. phone number) from person providing housing stating that client resides at address
- Voter’s registration
- Letter of award from Social Security (SSI/SSDI), Food Stamps, TANF, or VA
- Statement from a homeless shelter/homeless services provider attesting to homeless status
- Applicants with undocumented immigration status, may utilize a statement signed by case manager or eligibility worker and applicant, stating he/she does not have a valid state ID due to undocumented immigration status and does not possess documents that could otherwise be used to verify residency
|
|
|
INCOME
Must Bring ALL that apply to applicant and certain household members (i.e. spouse, partner, significant other, applicant’s children and/or anyone the applicant has shared bank account) |
- Most recent income tax return IRS 1040 or W-2 forms
- Bank statements (savings or checking) from the last 3 months with the bank’s name/logo
- If employed, pay stubs from the last 3 months
- If not available, Signed employer statement with dates, position , phone number and salary
- Unemployment income
- Rental income for the last 3 months
- Retirement statements for the last 3 months
- A recent TPQY/SEQY printout from Social Security
- Letter of award from Social Security (SSI/SSDI), Food Stamps, TANF, or VA
- If no income/unemployed, signed support letter from person providing assistance stating how applicant receives food, clothing, shelter, monthly allowance amount and how long assistance is expected to last
- In isolated cases for clients who have an undocumented immigration status, a statement signed by case manager or eligibility worker and client, stating client does not hold a valid INS work permit (authorization), and staff verified that client is not receiving any federal, state or county entitlements.
|
|
|
Health Insurance Coverage
*Having Health Insurance Does Not Automatically Exclude Applicant From Part A Eligibility |
- Insurance card and policy coverage document (Private Insurance, Medicaid, Medicare, VA, etc.)
IF Applicant is Employed and Not Enrolled in Health Insurance (one (1) of the following:
- Documentation that the applicant is not eligible to receive employer sponsored health insurance
- Documentation regarding when the next Open Enrollment period begins*
*Applicant will be required to enroll in employer sponsored insurance during next open enrollment period |
Other documentation may be acceptable.
Please contact CIED for information or special accommodations.
CIED Main Office
Broward Regional Health Planning Council
200 Oakwood Lane, Suite 100
Hollywood, 33021
954-566-1417
Required Plug-ins: 
Adobe® Reader®