If you have questions or need additional sources of help, please visit our Resources Page.
Language:
If you have questions or need additional sources of help, please visit our Resources Page.

Sample Documents

ATTENTION APPLICANTS:

Before uploading a scan or photo of your documents, make sure these are visible:

  • Your name
  • Date(s) showing the time frame for your enrollment in a public assistance program or for your proof of income

On the application, you will be asked to provide documents from the list below. You will upload these documents using the unique link you receive from the application form.

You may upload photos of your documents, or scan them and upload the scanned document. Sample documents include a form demonstrating your enrollment, an acceptance letter or anything indicating that the applicant is enrolled.

If you are unable to directly upload these documents, we can provide help.
Call 832-990-1318 for assistance.

Jump to section:
Self-certification Forms  |  Prove Household Income
Prove Eligibility  |  Prove Household Income  |  Identification  |  Harris County Address
Proof of Hardship due to COVID-19  |  Proof of Need due to COVID-19
Qualified Alien Documentation

Click the links for samples of the listed forms.

Self-certification Forms

Here are documents you need to prove your eligibility:

*Health and Human Services form can demonstrate receipt of these documents.
##Upload the “Notice about your case” document OR a screenshot of your benefits summary from the Texas Benefits site

Other documents include:

  • Head Start or Early Head Start
  • National School Lunch Program (NSLP)
  • Low Income Home Energy Assistance Program (LIHEAP)

Here are documents you need to prove your household income:

You must show that you are making less than 60% Area Median Income (AMI) or who are enrolled in one of the following public assistance programs.

You need to provide just one of these documents show you are receiving public benefits:

  • CHIP
  • Federal Pell Grant (2020-2021 Award Letter or Screenshot of Financial Aid award summary from school portal)
  • Gold Card (Harris Health) (Approval Letter)
  • Head Start
  • HUD Public Housing Assistance
  • Low Income Home Energy Assistance Program (LIHEAP)
  • Medicaid
  • National School Lunch Program (NSLP)
  • SNAP (Food Stamps)
  • Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
  • Supplemental Security Income (SSI)
  • Temporary Assistance for Needy Families (TANF)
  • Tribal Assistance
  • VA Pension

Proof of Income

For each adult household member (18 years of age or older), you will need to upload documents from List A or List B below:

List A:

  • 2019 tax return listing all adult household members
  • 2019 W-2(s) for every job held by each adult household member
  • 2019 1099(s) for every job held by each adult household member

If you cannot provide documents from List A, you may upload documents from List B:

List B:

  • One month of recent pay stubs
  • Profit & Loss statement/ledger
  • Declaration of income statement
  • Stipend(s), alimony, pension/retirement/annuity monthly award letter(s)
  • Letter from employer
  • Certification of Zero Income

Proof of Identification

Proof of Address within Harris County

  • Current photo ID with Harris County address
  • Current utility bill (water, gas, cell phone, internet, or other utility service) with name of the applicant (or household member) and Harris County address
  • Lease with name of the applicant (or household member) and Harris County address
  • Mail addressed in applicant’s name at residence with US postage
  • Proof of temporary residency: a letter of temporary residence with address of residence including name and contact information of person verifying residence, a current hotel/motel bill
  • Homeless: a statement saying that you are homeless and do not have any of these documents.

Proof of Hardship due to COVID-19

  • Unemployment filing, application, or statement (Screenshot the Claim and Payment Status tab on the unemployment website, do not crop image)
  • Letter from Workforce Solutions
  • Discharge, layoff, or furlough letter (Has to state that the release is COVID related)
  • Pay stubs showing reduction in work hours
  • Pay stubs showing reduction in income (All pay stubs from the last 30 days)
  • Letter from healthcare provider stating that you or a family member has been impacted by COVID-19 and/or required to quarantine
  • Notice of business closure (letter from employer of closure, closure announcement in newspaper, etc.)
  • Self-certification form

Proof of Need due to COVID-19

  • Late or unpaid rent bill or mortgage statement
  • Late or unpaid utility bill (water, electricity, gas), internet bill, or cable bill
  • Healthcare expenses or unpaid medical bills
  • Transportation needs (loss of vehicle or unpaid car note/loan)
  • Late or unpaid childcare expenses

Please refer to our Eligibility/Eligible uses page for additional information.