Proof of Income

Income can be verified by providing various types of documents such as the acceptable list below. One of the most common proofs is a pay stub. If you submit a pay stub, make sure that it is current and within the last 45 days; otherwise, Covered California may not accept it.

Many people find it easy to submit last year’s federal tax return, however it will not satisfy requirement for proof of Covered California income limits unless it accurately reflects your current income. If you have had income changes that are not reflected, then it will save you time in the long run to submit other documentation.

You will need one piece of documentation for each source of income that is listed on your Covered California application. For example, if you have W-2 income as well as self-employment income and rental income, you will need 3 pieces showing each unless you can provide one document that will show all three such as a tax return ,etc.

Please refer to the lists below under the three categories: Income from Employer, Income for Self-Employed and Miscellaneous Income.

Documents accepted for Covered CA

Pay stub must include:

• Name of person must be on stub or other identifying information to link to the person (i.e., SSN).
• Pay stub must be issued within the last 45 days showing the gross amount (include tips, overtime, commission and bonus).
• A pay stub or check indicating only net amount is not acceptable.

Documents accepted for Medi-Cal

• Pay stub not required to have been issued within the last 30 days but must accurately reflect the amount reported on the application.

Documents accepted for Covered CA

• Copy of last year’s federal tax return that accurately reflects the current income.
• Federal tax return must include: Applicant or other adult must be listed as filer.

Documents accepted for Medi-Cal

• Copy of last year’s federal tax return that accurately reflects the current income

Documents accepted for Covered CA

• Signed letter from employer. Letter from the employer must include:
  • Name of person employed
  • A signed statement stating “The information provided above is true and correct to the best of my knowledge.” or something similar.
  • Employer signature and date

Documents accepted for Medi-Cal

• Signed letter from employer. Letter from the employer must include: Employer signature and date

Documents accepted for Covered CA and Medi-Cal

• Pay stub, other documents

*Includes farm income

Documents accepted for Covered CA

• Receipts displaying the most recent 3-month gross profit and expenses
• Business records such as profit and loss statements. Records must include:
  • Signature of person claiming income and statement saying, “The information provided is true and correct.” Or something similar.

Documents accepted for Medi-Cal

• Receipts displaying profit and expenses
• Business records such as profit and loss statements

Documents accepted for Covered CA

• Copy of last year’s federal Income Tax form 1040 with Schedule C or Schedule C-EZ, 1040X with original 1040 & Schedule C

Documents accepted for Medi-Cal

• Copy of last year’s federal tax return (tax form 1040) along with federal Schedule C, D, E, or F as appropriate that accurately reflects current income

Documents accepted for Medi-Cal and Covered CA

• Form 1099
• Bank statement
• Investment account statement
• Payment records (notes and mortgages)

Documents accepted for Covered CA

• Pay stub. Pay stub must include:
  • Name of person must be on stub or other identifying information to link to the person (i.e., SSN).
• Award Letter or Bank Statement
• Form 1099
• 1040 or 1040A Tax Forms

Documents accepted for Medi-Cal

• Current bank statement if the applicant/beneficiary has direct deposit (Note: the income deposited may not reflect gross income if Medicare premiums are being deducted or any overpayment is being collected)
• Current benefit check (the income deposited may not reflect gross income if Medicare premiums are being deducted or any overpayment is being collected)
• IEVS/PVS statement
• Signed statement from the individual or organization providing the income

Documents accepted for Medi-Cal and Covered CA

• Pay stub
• Award letter or Bank Statement
• 1040 and 1040A Tax Forms (for IRA and Pension and Annuities)

Documents accepted for Covered CA and Medi-Cal

• Pay stub
• Paycheck
• Bank Statement or Award letter

Documents accepted for Covered CA and Medi-Cal

• Letter from school financial office
• Award Letter from school financial office

Documents accepted

• Letter from school financial office
• Award Letter from school financial office

Documents accepted for Covered CA

• Gift income letter: Gift income letter must include:
  • Name of person to whom the gift is made on a regular and ongoing basis (one time gifts not acceptable)
  • Signature of the gift giver and the date the gift was received (must be within the last 45 days).

Documents accepted for Medi-Cal

• Gift income letter

• Court orders/papers
• Copy of check or pay stub
• District Attorney/Family Support (DAFS ) records
• District Attorney Notice of Receipt
• Copy of pay stub showing garnishment specified for alimony
• Statement from parent making the child support payment
• Sworn affidavit from absent parent

Documents accepted for Covered CA

• Records such as gross rents and expense receipts
• 1040 Tax Form with a Schedule E (page 1), Rental Income Worksheet

Documents accepted for Medi-Cal

• Lease or sales agreement (Rental receipts, checks, lease agreements are acceptable.
• Records such as gross rents and expense receipts
• 1040 Tax Form with a Schedule E (page 1), Rental Income Worksheet

Documents accepted for Covered CA

• Income Documentation for Renting a Room form
• Copy of a payment receipt for renting a room
• Copy of any cancelled checks

Documents accepted for Medi-Cal and Covered CA

• Pay stub: Pay stub must include:
  • Amount reported on pay stub
  • Amount actually reported by the applicant/beneficiary
  • Statement, under penalty of perjury, in the event there is a discrepancy between the amounts reported on the pay stub as compared to the amount actually reported by the applicant/beneficiary.

View directions on how to submit your documents.

For additional support, read through our FAQ’s related to supporting documents.