In addition to an ID, clients must submit at least one other proof of residency. Clients may upload one of the following items:

1. Electric bill in client’s name

2. Current Vehicle Registration in client's name

3. Proof of ownership or purchase of homestead property in Polk County

4. Rent receipt for most recent week/month

5. Lease agreement showing current address and client's name

6. Recent award letter from state or federal agency

ALL documents MUST be in the client's name and show the client's current Polk County address.

*If the client is a renter and does not have any of the above listed items, complete and submit the Rental Verification Form.

*If the client can not provide any of these documents, a Declaration of Domicile form must be completed and submitted.

A Driver's License/Photo ID and one additional proof of residency documentation (as listed above) must be submitted for each adult (18+) in the household seeking care. Multiple files can be uploaded in the form fields below.

Clients must provide income documentation for ALL income earners of the household.

Along with pay stubs, the client can upload any of the following on behalf of all income-earners in the household.

• Tax Return
• Schedule SE, if self-employed this document is required. If self-employed and business is new, must provide expense records (bank statements or profit & loss statements) 
• Social Security award letter if applicable.
• Unemployment award letter if applicable.
• If there is no income, a Certification of Zero Income form must be completed and submitted. If spouse/partner is not working, they will need to complete this form

Multiple files can be uploaded in the form fields below.