Eligibility Information

Eligibility requirements vary depending on the service provided. Some services are free, some are provided at a flat fee and others have a fee based upon a sliding scale. Sliding scale means that the fee is relative to income. Financial eligibility is determined annually, as well as, whenever there is a change in financial status or income scale. Identification, as well as, proof of residency and income is required when services are provided.

Eligibility Services also provided assessment, referral and follow-up for financial and medical resources to our customers. The Peninsula Health District currently works with numerous pharmaceutical patient assistant programs to obtain medication for our customers. Quite often, we must request specific personal or income information (in addition to the verification that has been provided for Peninsula Health District services) to satisfy various program requirements.

Acceptable verification of financial status may include:

• Pay stubs- most recent 4 to 6 week period or (if applicable) most recent stub with year to date earnings
• Federal Tax Return- most recent year with supporting documentation (W2s, 1099s, schedules, etc.)
• Employer's written statement regarding gross earnings
• Notice of Action letters (food stamps, state and local hospitalization, general relief, TANF, etc.)from Department of Social Services
• Social Security/Retirement current year award letters and/or 1099 forms for previous year totals
• Unemployment Compensation- monetary determination letter or payment history from Employment Commission
• Child/Spousal support payments- support court order, check stubs/copies or (if indicated) letter of support
• Letter of Termination/Layoff Notice from most recent employer
• Letter of Referral (Healthcare for the Homeless, Youth Challenge, Serenity House, Community Service Board, etc.)
• Zero Income Self-Declaration in certain limited conditions

Questions regarding which verification is appropriate should be directed to Eligibility Services (757)594-7405

Questions regarding appropriate verification for WIC services should be directed to one of the following WIC Service locations:

Peninsula Health Center	757-594-7502
Denbigh Office	757-886-2810
Williamsburg Area Office	757-253-4742
East End Health Facility	757-247-2184

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