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BenefitsCheckUp®

Your Benefits are Waiting!

Here is what we will need for a successful screening and to complete your application:

Don't be intimidated by this list of documents.

Contact us at "Get Help Here" and we will explain the process to you first.


Graphic reading Needed for an Application

Proof of Residency - Includes, but not limited to:

  • Evidence of home ownership
  • Lease or other evidence of rental
  • Driver's license or vehicle registration
  • Voter registration card
  • Utility bills
  • Receipt or cancelled check from rent or mortgage payment
  • Employment record
  • Signed statement from the landlord
  • Collateral contact (unless homeless)

Graphic reading Needed for an Application

Proof of Identity - Includes, but not limited to:

  • Driver's license
  • State-issued non-driver's license ID
  • Social Security card
  • Voter registration card
  • Employee identification card
  • ID issued by the Public Housing Authority
  • Previously issued benefits card

Graphic reading Needed for an Application

Proof of Citizenship - Includes, but not limited to:

  • INS Form I-94 with codes and date stamps
  • Employment Authorization Card (INS Form I-688B)
  • Employment Authorization Document (INS Form I-766)
  • Refugee Travel Document (INS Form I-571)
  • Alien Registration Receipt Card (INS Form I-551)
  • Unexpired Temporary I-551 stamp in foreign passport or on INS Form I-94
  • Tribal Document or membership card (for Native Americans)
  • DD Form 214 or current Military ID card (for Veteran status)

Graphic reading Needed for an Application and Needed for Benefits Check Up

Proof of Income - Includes, but not limited to:

  • Letter from employer stating (a) salary or pay; or (b) wages and hours worked
  • Employment Income - pay stubs showing gross amounts (before taxes and deductions)
  • for at least 30 days
  • Self-employment - business receipts, accounting or other business records
  • Workers Compensation - copy of the benefit check or stub
  • Unemployment Compensation - UCB check stubs (30 days if applicable) or award letter
  • Insurance (Health and Life) - policy documents, insurance cards
  • SSDI or SSI Payments - award letter
  • Retirement Income
  • Social Security (OASDI) payment - award letter
  • Child Support or Alimony Income - court documents
  • CFSA Stipend or Federal Foster Care Payment - award letter or check stub
  • Other Income such as Rental or Room and Board Income (written statement from roomer or boarder, accounting records, lease or contract, or rent receipt book) or
  • Property Related Income

Graphic reading Needed for an Application and Needed for Benefits Check Up

Proof of Assets - Includes, but not limited to:

  • Checking, Savings (or Credit Union Draft/Share) Accounts - monthly statement
  • Savings Certificates, Certificates of Deposit (CDs), or Bonds - certificate or bond
  • Stocks or Bonds - certificates
  • Cash on hand
  • Personal Property - the values for items like campers/trailers, non-motorized boats, utility trailers not used for business
  • Pension plans or retirement accounts - the value minus any withdrawal penalties
  • Life insurance - the cash surrender value, not the amount that would be received because of the death of the insured person
  • Vehicle (second or more) - Blue book or NADA book wholesale (trade-in) value or loan statement/payment book
  • Other Assets

To see if you qualify for assistance, contact us in 1 of 3 ways:
  1. Submit the form under "Get Help Here" on this website
  2. Send an email to at bec@thewholeperson.org
  3. Call us at 816-561-0304

Download a PDF of the Benefits Checklist Paperwork

  • This PDF checklist provides a list of documents that people with Medicare may use/need when completing a BenefitsCheckUp® screening and applying for benefits.