| Family Planning Benefit Program: Checklist
Bring the information below to your confidential appointment. It is okay to bring photocopies of these documents, if you prefer.
If you are under 21 years old, and unsure about getting these documents, call us and ask to speak to our Financial Assessment Representative. It's easier than you think. Call 1-866-600-6886 (toll-free).
Bring the following information to your appointment:
Proof of Identity/Date of Birth (Bring one of the following)
- Drivers license
- Official photo identification card
- Passport
- Birth certificate
- Official school records
- Adoption records
- Official hospital/doctor birth records
- Naturalization certificate
- Marriage records
Residency/Home Address (Bring one of the following)
This proof must be dated within the past 6 months.
- Identification card with address
- Postmarked envelope, postcard, or magazine label with name and date
- Drivers license issued within past 6 months
- Utility bill (gas, electric, cable), bank statement or correspondence from a government agency which contains name and home address (not a P.O. box)
- Letter/lease/rent receipt with home address from landlord
- Property tax records or mortgage statement
Social Security Number
We just need your Social Security-we do not need to see your Social Security card. You can get your Social Security Number from:
- Social Security Card
- Application for Social Security Number (SS-5)
- Correspondence from Social Security
- Tax Return
Citizenship or Alien Status (Bring one of the following)
- U.S. Birth Certificate
- U.S. Baptismal record, recorded within 3 months of birth
- U.S. or other Passport
- Official hospital/doctor birth records
- Naturalization certificate
- INS form I-551 (Green Card)
- INS form I-94
- INS form I-220B
- INS I-210 letter
- INS form I-181
Proof of Income
If you have received any income in the most recent month, you must show proof of income. Bring ALL that apply:
Wages and Salary (most recent four weeks)
- Paycheck stubs OR
- Letter from employer on company letterhead, signed and dated
Self-Employment
- Signed and dated income tax return and all schedules OR
- Records of earnings and expenses
Unemployment Benefits
- Award letter/certificate OR
- Benefit check OR
- Correspondence from New York State Department of Labor
Private Pensions/Annuities
- Statement from pension/annuity
Social Security
- Award letter/certificate OR
- Benefit check OR
- Correspondence from Social Security Administration
Child Support/Alimony
- Letter from person providing support OR
- Letter from court OR
- Child support/alimony check stub
Worker's Compensation
- Award letter OR
- Check stub
Veteran's Benefits
- Award letter OR
- Benefit check stub OR
- Correspondence from Veterans Administration
Military Pay
- Award letter OR
- Check stub
Interest/Dividends/Royalties
- Statement from bank, credit union or financial institution OR
- Letter from broker OR
- Letter from agent
Income from Rent or Room/Board
- Letter from roomer, boarder or tenant OR
- Check stub
Support from other family members
- Signed statement or letter from family member
If you pay for health insurance, provide proof of payment amount. (Bring both)
- Insurance card AND
- Pay stubs or insurance bill
If you pay for child care, provide proof of payment amount. (Bring one)
- Note from day care center or child care provider OR
- Canceled checks or receipts
Return to Family Planning Benefit Program information.
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