Required Documents

IRS 1040 Form

Electronic copy of most recent submitted IRS 1040 Tax Form.

If the child is not listed on your most recently filed IRS 1040, please provide a copy of both your most recently filed IRS 1040 and the most recently filed IRS 1040 on which the child is listed as a dependent. Additional documentation (birth certificate and social security card) will be required in the event that your child is not on your most recent IRS 1040 (e.g. recent birth, adoption, etc.)

Insurance Card

Electronic copy of the front and back of current Commercial/Private insurance card.

Medical Condition Form

Completed and signed Physician Certification of Medical Condition Form.

Physician’s Certification of Medical Condition

IRS 1040 Form

Insurance Card

Medical Condition Form

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