Skip navigation links
Administration
Broward Addiction Recovery
Community Partnerships
Elderly & Veterans
Family Success
Civil Citation
Skip navigation links
Intake and Eligibility
Service Providers
Pharmacy Drug Formulary
In The Know
About Us
Important HIV/AIDS Links
Document Requirements
 

Ryan White Part A Client Eligibility Documentation Requirements
(PDF) View PDF Version

HIV DIAGNOSIS
Need Only One Document listed below.

  • Positive ELISA with confirming Western Blot test results
  • RNA-PCR or Branched DNA (BDNA) test showing detectable viral load of HIV virus

BROWARD COUNTY RESIDENCY
Need Only One Document
listed below. MUST be current/not expired with applicant’s name & current address.

  • Florida driver’s license OR Florida photo ID 
  • Utility bill
  • Homestead exemption
  • Lease and/or rental agreement
  • Rent receipts noting applicant’s name, address and landlord’s name
  • Letter and contact information (i.e. phone number) from person providing housing stating that client resides at address
  • Voter’s registration
  • Letter of award from Social Security (SSI/SSDI), Food Stamps, TANF, or VA
  • Statement from a homeless shelter/homeless services provider attesting to homeless status
  • Applicants with undocumented immigration status, may utilize a statement signed by case manager or eligibility worker and applicant, stating he/she does not have a valid state ID due to undocumented immigration status and does not possess documents that could otherwise be used to verify residency

INCOME
Must Bring ALL that apply to applicant and certain household members (i.e. spouse, partner, significant other, applicant’s children and/or anyone the applicant has shared bank account)

  • Most recent income tax return IRS 1040 or W-2 forms
  • Bank statements (savings or checking) from the last 3 months with the bank’s name/logo
  • If employed, pay stubs from the last 3 months
  • If not available, Signed employer statement with dates, position , phone number and salary
  • Unemployment income
  • Rental income for the last 3 months
  • Retirement statements for the last 3 months
  • A recent TPQY/SEQY printout from Social Security
  • Letter of award from Social Security (SSI/SSDI), Food Stamps, TANF, or VA
  • If no income/unemployed, signed support letter from person providing assistance stating how applicant receives food, clothing, shelter, monthly allowance amount and how long assistance is expected to last
  • In isolated cases for clients who have an undocumented immigration status, a statement signed by case manager or eligibility worker and client, stating client does not hold a valid INS work permit (authorization), and staff verified that client is not receiving any federal, state or county entitlements.

Health Insurance Coverage
*Having Health Insurance Does Not Automatically Exclude Applicant From Part A Eligibility

  • Insurance card and policy coverage document (Private Insurance, Medicaid, Medicare, VA, etc.)

IF Applicant is Employed and Not Enrolled in Health Insurance (one (1) of the following:

  • Documentation that the applicant is not eligible to receive employer sponsored health insurance
  • Documentation regarding when the next Open Enrollment period begins*

*Applicant will be required to enroll in employer sponsored insurance during next open enrollment period

 
Other documentation may be acceptable. 
Please contact CIED for information or special accommodations.

CIED Main Office
Broward Regional Health Planning Council                             
200 Oakwood Lane, Suite 100
Hollywood, 33021  

954-566-1417  

                      

Required Plug-ins: PDF icon  Adobe® Reader®