Bay Area Benefits Access Fair

In Collaboration with La Porte/Cleveland Ripley Neighborhood Centers

Thursday, June 28, 2012 8:30 AM 1:00 PM

United Way Service Center of the Bay Area 1300 Bay Area Blvd., Bldg. A Houston, Texas 77058 For information call 281-282-6000

Following services are being provided:

Free Health, Dental and Vision Assistance Medical Financial Assistance for Harris County Resident Food Stamp, Medicaid & CHIP Application Assistance Workforces Solutions Services Free saving and/or checking Account to help gain Financial Wellness Employment & Financial/Education Counseling Continue Education Programs Utility Assistance for Harris County Resident Help with Transitioning from Homelessness to Permanent Housing Immigration/Legal Services Information on owning your home Food Fair (bring a bag, basket, container or box)

Participating Community Agencies:

ABC Dental Clinic Harris County Hospital District Houston Food Bank Family Promise of Clear Creek YWCA Bay Area Habitat For Humanity Shell Federal Credit Union San Jacinto College Bay Area Financial Opportunity Center Neighborhood Centers Inc. Workforce Solutions Home Helpers University of Houston Immigration Clinic Ennis Chiropractic

Please see reverse side for documents that you need to provide for these benefits.

To apply for medical financial and utility assistance and Food Stamps, Medicaid, or CHIP provide the following documents for all applying for benefits:
1. Identification for applicant and spouse: * Current Texas Driver's License or ID * Student ID with picture or Birth certificate * Passport with picture or Resident Alien card * ID issued by Consulate or Visa * Social security cards for all applying for benefits 2. One Proof of Address: last 60 days * Utility bills or Mortgage coupon * Lease agreement or Credit card statement

3. Proof of All Household Income: last 30 days * Last 4 check stubs, if weekly * Last 2 check stubs, if bi-weekly * Food stamp or TANF certification letter * If self-employed, all pages of current Form 1040 * Texas Workforce Commission Unemployment Letter * Supplemental Security Income (SSI), Social Security Disability (SSD), or Social Security Retirement Award Letter for 2012, Monetary Gifts Court order decree for child support or divorce decree

4. Proof of Household Composition * Birth certificates of children / dependents * Baptismal record * Income Tax Form 1040

5. Proof of Immigration Status, if applicable * Naturalization Certificate or Passports * Resident Alien cards or Visa * Border crossing passes * Employment authorization cards 7. Medicare Patients * Medicare identification Card * Bank statements (dated for the last 30 days) * Credit card statements (for the last 30 days)

6. Proof of Other Healthcare coverage, if applicable * Insurance card (front & back) * Current month Medicaid slip * CHIP Card

8. Proof of All Household Expenses

* Rent or mortgage payment, utility bills, medical bills, child care support, loans, etc. (paid over the past two months) Bring current light and gas bill (front and back) no more than 30 days old and any disconnect notices. If disable bring disability letter from Social Security

9. Proof of Resources
* checking or savings account statements

If you are applying for medical assistance and pregnant, you will need to provide proof of pregnancy showing expected delivery date. These are minimum requirements depending on each individual situation.