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Eligibility Requirements

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Eligibility Information 

What is Eligibility and why would I need it?

Financial Eligibility Determination is offered to clients to determine if a sliding fee scale based on household income is applicable. Our staff can determine your cost of medical care through the health department and may suggest other services and programs that you may not be aware of.

What do I need to bring?

To determine eligibility, you will need to bring the following documents to your interview:

  • IDENTIFICATION - Driver's License or other picture identification for applicant, spouse, and minor children.
  • PROOF OF RESIDENCY - Current utility bill (water, phone, electric) or lease/rent paperwork (receipt/agreement).
  • ASSETS - Current statement for bank accounts (checking, savings, stocks, bonds, certificate of deposit)
  • PROOF OF INCOME
  • Last four (4) pay stubs, or
    • Letter from employer on company letterhead stating hourly wage and number of hours worked.
    • Award letter from Social Security (if applicable)
    • Proof of child support (if you receive this income)

If you are self-employed, you will need your latest income tax return showing profit and loss OR a record of profit and expenses.

If you are unemployed, you will need to provide a notarized “Statement” or  “Letter of Support” from the person who is paying or helping to pay your expenses stating when you became unemployed and detailing how you are being supported.

Additional Programs 

Ask your eligibility counselor about the below programs that are also available through our office.

Florida Breast and Cervical Cancer Early Detection Program: Grant program for uninsured women 50 to 64 that qualify financially to pay for PAP and mammograms.